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Flashcards in Week 3 Deck (105)
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1

What are the definitions of polypharmacy?

• Administration of many drugs together
• Administration of excessive medication
• Excessive or inappropriate use of medications

2

Why do older adults consume more drugs as compared to their younger counterparts?

• More illness
• More adverse drug reactions (ADRs)
- Altered response to drug therapy
• Physician reliance on drug therapy over non pharmacologic options
• Multiple prescriptions from multiple providers
• Over the counter and self-help remedies
• Sharing of medications

3

What is included in the polypharmacy cycle?

- More illness in older adults leads to
- Need/take more drugs leads to
- Increased risk of side effects leads to
- Side effects seen as symptoms leads to
- More drugs administered leads to
- More illness in older adults

4

What are the characteristics of polypharmacy?

• Use of medications for no apparent reason
• Use of duplicate medications
• Concurrent use of interacting medications
• Use of contraindicated medications
• Use of inappropriate dosage of medications
• Use of drug therapy to treat ADRs
• Patient improves with discontinuation of medications

5

What are pharmacokinetic changes?

How the body handles the drug

6

What are the pharmacokinetic changes in response to drugs?

• Absorption- altered gastrointestinal function
• Distribution- changes in total body water, lean body mass, % body fat, plasma protein concentrations
• Metabolism- reduced liver mass, decreased hepatic blood flow, decreased activity of drug metabolizing enzymes
• Excretion- decreased renal blood flow and mass, decreased function of renal tubules

7

What do pharmacokinetic changes result in?

Drugs and drug metabolites remaining active for longer periods of time and prolonging drug effects thereby increasing risk for toxic side effects.

8

What are pharmacodynamic changes?

How drugs affect the body

9

What are the physiologic systemic pharmacodynamic changes seen in the body?

• Homeostatic control of circulation – impacts cardiovascular drugs
• Impaired postural control
• Decreased visceral muscle function
• Changes in thermoregulation
• Declining cognitive ability

10

What are the cellular level pharmacodynamic changes seen in the body?

Binding receptor changes
• Increased or decreased sensitivity

11

What are the biochemical response pharmacodynamic changes seen in the body?

Subcellular structural and functional changes

12

What are the common GI symptoms seen as a result of an adverse reactions to medication in the older adult?

Nausea, vomiting, diarrhea, constipation

13

In what medications are GI symptoms a common adverse reaction?

Common with opioids, non-opioids, and NSAIDS

14

In what medications is sedation a common adverse reaction?

Common with opioids, analgesics, antipsychotics

15

When is excessive sedation seen as a common adverse reaction to medication?

With sedative-hypnotics

16

In what medications is confusion a common adverse reaction?

Common with antidepressants, narcotic analgesics, drugs with
anticholinergic activity

17

In what medications is depression a common adverse reaction?

Common with barbiturates, antipsychotics, alcohol, some
antihypertensive drugs

18

In what medications is orthostatic hypotension a common adverse reaction?

Most common with drugs used to treat hypertension

19

In what medications is fatigue/weakness a common adverse reaction?

Common with skeletal muscle relaxants and diuretics (altered electrolyte balance)

20

In what medications is dizziness/falls a common adverse reaction?

Common with sedatives, antipsychotics, opioid analgesics, antihistamines

21

What do anticholinergic effects do as a common adverse reaction to medications?

Alters response of tissues to
acetylcholine

22

In what medications is an anticholinergic effect a common adverse reaction?

Common with antihistamines, antidepressants, and
antipsychotics

23

What are the CNS anticholinergic effects as a result of medication?

Confusion, nervousness, drowsiness, dizziness

24

What are the PNS anticholinergic effects as a result of medication?

Dry mouth, constipation, urinary retention, tachycardia, blurred vision

25

What are the extrapyramidal symptoms seen as a result of an adverse reactions to medication in the older adult?

Dsytonias, tardive dyskinesia,
pseudoparkinsonisms

26

In what medications are extrapyramidal symptoms a common adverse reaction?

Common with antipsychotics

27

What are the the general strategies for the physical therapist when treating a patient on medication?

• Differentiate between diagnosis/disease sequelae and
ADRs
• Identify polypharmacy and refer for reevaluation of meds
• Schedule according to drug effect and rehab needs
• Encourage adherence to prescribed medication regimen
• Provide education on why prescribed meds may be
beneficial and their potential side effects
• Implement non-pharmacologic options to manage conditions

28

What are the generalized goals of therapy when working with patients with Parkinson's?

• Maintaining or increasing activity level
• Decreasing rigidity or bradykinesia
• Optimizing gait
• Improving balance and motor coordination

29

What are the benefits of exercise in patient with parkinson's?

• Increase synapses formed
• Increased blood vessels in the brain
• Increased cell survival factors
• Better use of remaining dopamine
• Lowers the risk of PD for those with +genetic & environmental factors
• Protects vs. development of PD
• Improves efficacy of levodopa improves cognitive function
• Improves scores reported on QOL measures
• Decreases depression & apathy
• Improves stress & reported fatigue
• Decreases rigidity and bradykinesia

30

People with PD CAN learn new tasks and improve functional performance through __ during therapy.

People with PD CAN learn new tasks and improve functional performance through *FOCUSED PRACTICE OF
TASKS* during therapy.”