polypharm

Question 1

BP changes in older adults

Answer 1

systolic HTN

orthostatic HTN

Question 2

hear rate and rhythm in older adults

Answer 2

packmaker cells and maximal heart rate decline

more likely to have abnormal heart rate

Question 3

temperature changes in older adult

Answer 3

more susceptible to hypothermia

Question 4

skin changes in the older adult

Answer 4

vascularity of the dermis decreases
skin may appear thin, fragile, loose and transparent
actinic purpura-blood that has leaded through the capillaries

Question 5

eye changes in the older adults

Answer 5

fewer lacrimations

Question 6

visual acuity in the older adult

Answer 6

gradually diminished between 50 and 70

near vision blurs for all older adults

Question 7

lens affects in the older adult

Answer 7

increase risk for cataracts, gluacoma, macular degeneration

Question 8

head and neck changes in older adults

Answer 8

decrease salivary secretions and sense of taste often med related
teeth disease

Question 9

lung and thorax changes in older adult

Answer 9

chest wall stiffens and hard to move
respiratory muscle may weaken
lungs lose some elastic recoil
cough is less effective

Question 10

cadiovascular changes in the older adult

Answer 10

neck and vesels-systolic bruits in middle to upper portion of the carotid arteries suggest arterial obstruction from atherosclerosis
Extra heart sounds (S3 and S4)
S3 suggestive of CHF
S4 suggest decreased ventricle compliance
Murmurs

Question 11

what is the most common complaint in the older adults

Answer 11

memory loss

Question 12

what is mini mental status used to examine?

Answer 12

test cognitive function among older adults
Orientation
Attention
Memory
Language
Visual-spatial skills
score 0-30

Question 13

what type of patient typically scores 19-24 on a MMSE

Answer 13

alzheimers

Question 14

GI changes in older adult

Answer 14

decreased gastric acid
delayed gastric emptying
slowed intestinal transit time
reduced GI blood flow
decreased stomach acid leafs to decreased absorption of some meds

Question 15

pharmacokinetic changes

Answer 15

increased body fat and decreased muscle mass
meds distribute into have have increased volume of distribution
caution with meds like
-diazepam and chlordiazepoxide
meds that distribute into muscle or body water have decreased distribution
-Lithium

Question 16

protein binding in the older adults

Answer 16

serum albumin usually unchanged in healthy older adults but low in frail or malnourished elderly patients

Question 17

liver changes

Answer 17

metabolism primarily occurs in the liver
liver can be 20-40% smaller and accompanied by a 35% decrease in hepatic flow
meds with higher 1st pass will shower higher bioavailability
metoprolol, verapamil, morphine, diazepam

Question 18

GU changes

Answer 18

reduction in renal mass, renal blood flow, GFR, filtration fraction and tubular secretions
Scr derived from muscle mass and assess kidney function not accurate in older adults d/t decreased muscle mass

Question 19

what will happen to an adult taking at least 5 meds

Answer 19

1 in 3 will experience ADR

95% predictable and 28% preventable

Question 20

causes of ADR in older adults

Answer 20

polypharmacy
multiple comorbid conditions
poor med adherence
age related pharmacokinetics

Question 21

what is polypharmacy

Answer 21

over utilization or inappropriate use of multiple meds

Question 22

RF for polypharmacy

Answer 22

Women>men
Institutionalized>independent
co-morbiditied>healthier elderly
>65yrs old
Un-insured
cognitive impairment

Question 23

reason for polypharm

Answer 23

MD/PA/NP are instructed to treat according to guidelines
HTN, DM, COPD, Mental illness
Practitioners/pts/families may want to treat all symptoms
Prescribing Cascades
Treating medication side effects with another drug

Question 24

examples of prescribing cascades

Answer 24

antipsychotics-extrapyramidal signs-antiparkinson therapy

NSAID-inceased BP-HTN Tx

Question 25

contributing factors

Answer 25

``` lack of med renconciliation after hospital discharge lack of continuity of care multiple PCP Mulpt Docs and pharmacies quick med changes- start low go slow ```

Question 26

complications of polypharm

Answer 26

functional ability- financial, communication, food shopping, cooking, transport nutritional status- wt loss, trouble eating, mobility cognition- temporal orientation, calculation associated with depression and increased suicides

Question 27

hepatic enzyme inducer and examples of them

Answer 27

inducers can increase metabolism and decrease Rx concentration -Grapefruit, Herbal prep- st jogn wort, alcohol, tobacco, cannabis, barbiturates, tegretol, dilantin

Question 28

drugs that decrease metabolism and increase Rx conc

Answer 28

Prozac Erythromycin CCB meds with long half life and narrow therapeutic window Lithium,Digoxin,Wafarin

Question 29

Increased sensitivity

Answer 29

psychoactive meds long acting benzo antipsychotic agents TCA Adverse effects falls are major risk orthostatic HTN confusion

Question 30

age related receptor site changes can increase sensitivity

Answer 30

opioids wafarin Diphenhydramine NSAID

Question 31

how to prevent ADR

Answer 31

always start with lowest dose check for geriatric dosing recommendations Identify RF medication review regimen

Question 32

what is medication regiment review (MMR)

Answer 32

Evaluation of medication regimen Promoting positive outcomes Minimizing adverse events

Question 33

MRR indications

Answer 33

``` Indication/reason for medication Effectiveness Dose Presence of monitoring Presence of duplicative therapy Food and or drug interactions Presence of potential adverse drug reactions (ADR) ```

Question 34

when to do a MRR

Answer 34

Review of patient’s medications should be done at initial assessment, every 3 to 6 months thereafter, and with any medication change check to make sure Rx are not just treating symptoms need to establish accurate diagnosis

Question 35

beers criteria

Answer 35

For patients > 65 years of age Based on expert consensus developed through an extensive literature review evaluated by experts in geriatric care, clinical pharmacology, and psychopharmacology Adopted by the Centers for Medicare and Medicaid Services in July 1999 for nursing home regulation