Wk 2 - Older Adults

Question 1

____% of older adults take ___ or more meds per week

Answer 1

40% = 5 or more meds
12% = 10 or more meds

Question 2

Older adults purchase ___% of all OTC meds

Answer 2

40%

Question 3

Older adults’ functional reserve of systems _______, resulting in

Answer 3

decline

orthostasis, vision problems, cognitive decline, kidney and hepatic decline

Question 4

Almost ___% of people with chronic illnesses don’t take meds as prescribed,

Answer 4

50%

Question 5

About ____ % of patients do not fill prescriptions

Answer 5

30%; this is improved by age, no copay, and close relationship with provider

Question 6

Among older patients, _______ is least affected in terms of pharmacokinetics

Answer 6

absorption

Question 7

Drugs that can cause cognitive impairment:

Answer 7

■ All triclycic antidepressants (TCA)
■ Benzodiazepines
■ Metoclopramide
■ Anticholinergics
■ Chlorpromazine
■ Beta-blockers
■ Corticosteroids
■ Digoxin
■ Levodopa
■ H2 receptor antagonist (Cimetidine)
■ Lithium
■ NSAIDs
■ Phenytoin 
■ Quinidine 
■ Meperidine 
■ Zolpidem

Question 8

Pharmacological concerns with diminished cardiac output in older adults:

Answer 8

• Decreased metabolism / elimination and increased circulation time
• Reduced absorption of oral meds
• Increased time for vaginal and rectal meds to dissolve and maybe expelled prematurely

Question 9

Altered peripheral vascular tone and reduced baroreceptor activity can result in increased effect of

Answer 9

diuretics and antihypertensives

Question 10

Oxybutynin used for urinary incontinence can cause _______ in older adults

Answer 10

glaucoma

somnolence

Question 11

Metformin can cause in older adults:

Answer 11

urinary issues
GI side effects
watch GFR <45
contraindicated with chronic alcohol use

Question 12

Dosing of medications usually should be _______ for older adults

Answer 12

decreased

Question 13

Older adults tend to have ______ albumin

Answer 13

decreased

Question 14

Older adults tend to have ______ free drug

Answer 14

increased

Question 15

Older adults tend to have ______ liver mass and hepatic blood flow

Answer 15

decreased

Question 16

Older adults tend to have ______ enzymes

Answer 16

decreased

Question 17

Highly protein-bound medications will result in ______ free drug levels in older adults

Answer 17

increased

Question 18

Benzodiazepines are typically ____ in older adults and can cause:

Answer 18

contraindicated

cognition impairment, increase fall risk

Question 19

Metoclopramide/Reglan can cause ____ in older adults

Answer 19

mental status changes

Question 20

Older adults tend to have ______ total body water

Answer 20

decreased

Question 21

Older adults tend to have ______ total body fat

Answer 21

increased, higher concentration of fat soluble drugs in adipose tissue

Question 22

Older adults tend to have higher gastric pH, delayed emptying and decreased gastric acid, resulting in…

Answer 22

..reduced absorption of low ionized drugs with low pH

Question 23

Older adults tend to have ______ gastric pH

Answer 23

increased

Question 24

Older adults tend to have ______ cardiac output

Answer 24

decreased

Question 25

Older adults tend to have ______ GFR / tubular secretion

Answer 25

decreased

Question 26

Older adults tend to have ______ risk of adverse drug reactions

Answer 26

increased

Question 27

Older adults tend to have ______ transfer across blood brain barrier

Answer 27

increased

Question 28

Older adults tend to have ______ change in receptor properties

Answer 28

increased

Question 29

Adverse drug events cause _____ among older adults

Answer 29

> 100,000 deaths annually

Question 30

Strongest predictor of polypharmacy and adherence issues in older adults

Answer 30

Number of meds

Question 31

Between ______% of older adults have polypharmacy and adherence issues

Answer 31

25-50%

Question 32

Beers Criteria is intended to

Answer 32

• Improve medication selection
• Reduce adverse drug events
• Educate both patients and clinicians

Question 33

What pharmacokinetic property is least affected among older adults?

Answer 33

Absorption

Question 34

By 2050, the elderly population will reach ___% and ___% of population will be >79 years.

Answer 34

22%

20%

Question 35

Older adults with seizure / epilepsy have lower seizure threshold when taking:

Answer 35

antipsychotics (-ines), bupropion, tramadol

Question 36

Older adults should minimize total number of ________ class drugs to minimize cognitive impairment

Answer 36

anticholinergics

Question 37

Older adults have increased fall risk when combining _____ with >2 other ________

Answer 37

opioids

CNS active medications

Question 38

Older adults taking warfarin and ______ have increased bleed risk

Answer 38

NSAIDs

Question 39

Aspirin for primary prevention in patients >80 should be _______ due to ________ changes

Answer 39

used with caution

renal function

Question 40

Hyponatremia in older adults can be caused by medications due to __________ and _____ changes should be considered

Answer 40

renal function changes

dosing

Question 41

STOPP/START tool shown to _____ in hospital in RCT

Answer 41

decrease ADR

Question 42

This afib med should not be used first line among older adults

Answer 42

Amiodarone