prescribing in elder

Question 1

TCA with older adults - main side effects

Answer 1

hypotension with position changes, sitting to standing

Question 2

citalopram in OA

Answer 2

• max dose should be 40/d because prolongs QT
• if over 60 yo dont give anyone more then 20mg/d
• dont give if prolonged QT, brady, MI, HF, low mg or K
• dont give over 20 if on tagamet or cimetidine (PPI)
• if QTC >500 DC

Question 3

Best SSRI for OA

Answer 3

• only SSRI with no other drug to drug reactions
• low anticholinergic
• good half life
• Escitalopram (lexapro)
• citalopram (celexa)

Question 4

psychotropic med low anticholingeric and low sedation in OA

Answer 4

sertraline

Question 5

SSRI to avoid in OA

Answer 5

paroxetine and fluoxetine because high AC

Question 6

TCA to give in OA

Answer 6

trazodone and mirtazapine

Question 7

TCA to avoid in OA

Answer 7

amitriptyline and nortriptyline

Question 8

what part of drugs changes as we age

Answer 8

pharmacokenetics (absorption, distribution, excretion) not pharmacodynamics

Question 9

Do CYP450 levels drop or increase after 70

Answer 9

drop

Question 10

what is the CYP450 1A2 affected by in OA

Answer 10

estrogen

Question 11

Beers criteria

Answer 11

list of meds that should not be given to older adults

Question 12

main types of drugs to avoid in OA and why

Answer 12

AC

cant see, cant pee, cant spit, cant shit, hyperthermia, tachy, confusion

Question 13

AC examples

Answer 13

Benadryl, TCA, SSRI, oxybutin ditropan

Question 14

aspirin use in the OA

Answer 14

If you have no cardiac hx - dont use for primary prevention over 80yrs because the risk of bleed is high
-once 85 no use for 2ndry prevention
-

Question 15

A1C goal in OA

Answer 15

<8

Question 16

what drugs in regard to respiratory dont work as well on OA

Answer 16

beta agonists (albuterol, salmetrol)
beta blockers (
use inhaled musinaric -tioropium and ipatropium
use CCB

Question 17

statins and OA

Answer 17

no evidence to start statins in OA >76 with out cardiac risk - if there is hx or risk you can continue

Question 18

PPI in OA

Answer 18

decrease iron, B12 and calcium therefore put at higher risk for osteo

Question 19

bactrim SE

Answer 19

hyperlakelmia

Question 20

when should you give ACE or ARB in OA

Answer 20

in the AM because allows normal overnight excretion of K

Question 21

cholinesterase inhibitors in OA

Answer 21

cause syncope and brady
-may need pace maker insertion

EX:
donepezil (Aricept, Aricept ODT)
tacrine (Cognex) (This medication is discontinued in the US)
rivastigmine (Exelon, Exelon Patch)
galantamine (Razadyne or formerly Reminyl)
memantine/donepezil (Namzaric)

Question 22

what has a high risk of bleed in those over 75

Answer 22

dabigatrain ( esp when compared to warfarin)

Question 23

Gout sx

Answer 23

redness at the first metatarsopharengeal joint

Question 24

gout tx

Answer 24

controller: uloric (Febuxostat), allopurinal
flare: NSAIDS and colchicine

Question 25

what causes gout flares

Answer 25

thiazies, organ meat, alchol

not increase in acidic foods

Question 26

age changes 
body weight as water- 
lean muscle mass- 
% body weight as fat-
serum albumin-
kidney weight - 
hepatic blood flow-  
ap diameter-
residual volume left in lungs -

Answer 26

body weight as water- decreases 
lean muscle mass- decreases 
% body weight as fat- increases 
serum albumin- decreases 
kidney weight - decreases 
hepatic blood flow- decreases 
ap diameter- increases 
residual volume left in lungs - increases