Pharmacotherapy and Polypharmacy

Question 1

what are the biological mechanisms associated with the process of aging

Answer 1

damage to mitochondrial and nuclear DNA caused by increased oxidative stress
increased lipid peroxidation
telmoere shortening
altered gene expression
upregulation of cell apoptosis

Question 2

What describes the manner in which the body affects a drug

Answer 2

Pharmacokinetics

Question 3

what described the manner in which the drug affects the body

Answer 3

pharmacodynamics

Question 4

What term is used to describe the ratio of total drug in the body to the amount od drug in plasma

Answer 4

volume of distribution

Question 5

What is directly related to the volume of distribution

Answer 5

plasma half life of a drug

if volume of distrubition increases the drug is retained LONGER in the body

Question 6

What antibiotics require adjustment in renal dysfunction

Answer 6

aminoglycosides, cephalosporins, fluoroquinolones, PCN

Question 7

What anticonvulsants require adjustment in renal dysfunction

Answer 7

gabapentin, oxcarbazepine, primidone

Question 8

what cardiovascular agents require adjustment in renal dysfunction

Answer 8

lisniopril, ramipril, satolol, diuretics, digoxin

Question 9

What is the study of the phsyiologic and biochemical effects that drugs have on the body

Answer 9

pharmacodynamics

Question 10

an increase in sensitivty to what medication increases the risk of falls and hip fractures

Answer 10

bnezodiazipines

Question 11

how is polypharmacy defines

Answer 11

taking atleast 2-9 medications concurrently

definition is controversial

Question 12

how is excessive polypharmacy diagnosed

Answer 12

taking >10 medications concurrently

Question 13

What are the potential consequences of polypharmacy

Answer 13

adverse drug reactions
increased direct costs
drug interactions
no-adherence
diminished functioanl status
geriatric syndromes

Question 14

why are geriatric patients at high risk for drug-drug inteactions

Answer 14

• polypharmacy
• comorbidities
• decreased nutritional status

Question 15

what are the most common drug-disease interactions

Answer 15

• aspirin and PUD
• CCB and HF
• BB and DB

Question 16

what are drug-drug interactions significant

Answer 16

may …
- decrease efficacy of drug
- increased risk of drug toxicity

Question 17

what are outcomes of non-adherence

Answer 17

• disease progression
• treatment failure
• hospitalization
• ADRs

Question 18

What are the drugs most commonly associated with delirium

Answer 18

opioids
benzodiazepines
anticholinergics

Question 19

What drug classes can exacerbate dementia

Answer 19

benzodiazepines
anticonvulsants
anticholinergic drugs (TCAs, in particular)

Question 20

What medications are most concerning for falls

Answer 20

psychotropic and cardiovascular medications

Question 21

What is higher medication use associated with in regards to nutrition

Answer 21

decreased intake of soluble and no soluble fiber
decreased intake of fate-soluble vitamins, B Vitamins and minerals
increased intake of cholesterol and glucose
increased intake of sodium

Question 23

What is the SAIL method

Answer 23

used to reduce polypharmacy
Simple, Adverse effects, Indications, List

Question 24

What is the TIDE method

Answer 24

used to reduce polypharmacy
Time, individualize, drug interactions, educate.

Question 25

What dermatologic diseases are associated with chronic pain

Answer 25

pressure/ischemic ulcers, burns, scleroderma

Question 26

What GI diseases are associated with chronic pain

Answer 26

Constipation, IBS, diverticulitis, IBD

Question 27

What CV diseases are associated with chronic pain

Answer 27

advanced heart disease, peripheral vascular disease

Question 28

what pulmonary diseases are associated with chronic pain

Answer 28

advanced COPD. pleurisy

Question 29

what rhematologic diseases are associated with chronic pain

Answer 29

OA, RA, gout, pseudogout, Spinal stenosis, etx

Question 30

what endocrine diseases are associated with chronic pain

Answer 30

diabetic neuropathy, pagets disease

Question 31

what nephrologic diseases are associated with chronic pain

Answer 31

chronic cystitis, ESRD

Question 32

what immune diseases are associated with chronic pain

Answer 32

HZV, post-herpetic neuralgia, HIV/AIDS neuropathy

Question 33

what neurologic diseases are associated with chronic pain

Answer 33

HA, peripheral neuropathy, compressive neuropathies, parkinsons, post-stroke pain

Question 34

What are risk factors for chornic pain

Answer 34

advancing age female lower SES/ education obesity tobacco use hx injury/physically strenuous job childhood trauma depression/anxiety

Question 35

What are elements of a comprehensive geriatric pain assessment

Answer 35

sensory emotional functional sleep attitudes/beliefs coping styles tx expectations/goals resources

Question 36

what type of medicatiosn can be effective in some patients for pain flares

Answer 36

NSAIDS

Question 37

What needs to be checked with NSAID use in geriatric populations

Answer 37

blood pressure checks renal function tests assess for GI adveser effects for those taking oral NSAIDS > 2 weeks

Question 37

what should be considered for nociceptive pain in those who do not respond to acetaminophen/NSAIDs

Answer 37

Tramadol

Question 38

what drug drug interactions are seen with tramadol

Answer 38

SSRI and SNRIs increased risk of seizures and serotinin syndrome when taken in combo

Question 39

What TCA should be avoided in geriatrics

Answer 39

amitriptyline becuase of adverse effects

Question 40

What are non-pharmacologic interventions for pain

Answer 40

CBT self management programs exercise intervetnions