Topic 17 Flashcards Preview

Pharmacology > Topic 17 > Flashcards

Flashcards in Topic 17 Deck (12):
0

What are 3 things to consider when considering evaluation of benefits

Comprehensive geriatric assessment

Prioritize outcomes (what is most important to patient )

Life expectancy

1

What are some differences between adrs and ades?

Adr is adverse drug reaction. They are the direct side effects of the drug taken at appropriate levels, often unintended and noxious.

Ade is adverse drug event. It is a broader category, could be some event that occurs due to some event which occurs due to a s/e.
They are usually more preventable.

They are both common causes of hospitalization especially in geriatric patients.

2

What are some definitions of polypharmacy and what are some results?

Taking at least one unnecessary drug. Taking 5 or more drugs, etc.

Increased ADR, increased hospitalization, increased severity of adrs poorer compliance increased medication errors
,

3

What 8 side effects are most worried about in Geriatric

Fall, incontinence, weakness fatigue delirium/dementia anorexia weight loss dizziness

4

Why is polypharmacy common?

Drs learn to prescribe not the opposite. Patients expect meds. Meds for adrs. Severe illnesses

5

What does avoid too many Stand for?

Alternatives

Vague sx

OTC/prns

Interactions

Duration

Therapeutic insteAd of preventative

Once a day

Other mds

Money to buy most important drugs

Adrs - don't treat with drugs

Need?

Yes/no? Compliance



6

What drugs should not be used in geriatric patients?



Indomethacin-worst cns effects of NSAIDs

Muscle relaxants-anti cholinergic and sedative

Tricyclics-same as above.

Digoxin-renal toxicity

Benzodiazepines-increased half life in elderly=sedation and falls

Meperidine-not as effective as other narcotics

7

What should be considered with absorption in gero pts.

It pretty much the same.

Some decrease in gastric motility and blood flow

And increase in ph

8

What are some things to consider with pharmacodynamics in gero? What usually happens with sensitivity, an example? What things vary in gero? Whats an example of an exception? What are 3 things that increase sensitivity in the elderly? Examples?

Sensitivity to drug usually increases with age...sedatives

But sometimes decreases....beta blockers

It is all variable...person to person, med to med

Also, age related changes, underlying illnesses, or frailty can increase sensitivity:

Orthostatic hypotension

Delirium

Frail patients have diminished reserve capacity.

9

What two things should be considered in distribution in gero? examples of drugs?

Serum albumin decreases in sick and malnourished patients making some drugs more toxic (phenytoin)

With age, total body water decreases leading to less distribution of water soluble drugs and thus more drug in plasma and more side effects (digoxin)

With age, fat increases leading to more distribution of fat soluble drugs and thus longer half lives and thus more side effects (amiodarone)

10

What should be remembered concerning liver metabolism in gero patients?

Some drugs (not all) are made inactive in the liver. More rarely, drugs are activated in the liver (pro drugs such as plavix and codeine)

Cytcochrome p450 goes through age related decline so phase 1 metabolized drugs are effected but phase 2 not as much.

11

What is an example of an inhibitor in the liver?

Haloperidol (antipsychotic) inhibits cyp2d6 thus preventing the metabolism of metoprolol (a beta blocker)