NURS 306: Week 5 - Playing by Different Rules: Geriatric Pharmacotherapy

What is polypharmacy?

When someone has a high number of medications they're using.

How many medications is associated with increased harmful risks?

≥5.

How many medications is considered hyperpolypharmacy?

>10.

It's always bad to have so many medications (True/False).

False

1 multiple choice option

What is a possibility when we focused too much on preventing polypharmacy?

Under-utilization of indicated therapies.

What matters the most when it comes to medication therapy in older adults?

The appropriateness of the medications

3 multiple choice options

What are 3 main reasons why older adults are particularly susceptible to polypharmacy and its adverse effects?

- Altered response to medications

- Multimorbidity

- Changes to benefits and risks

What is pharmacokinetics?

What the body does to the drug.

What are the 4 main components of pharmacokinetics?

- Absorption

- Distribution

- Metabolism

- Elimination

What is pharmacodynamics?

What the drug does to the body.

How does absorption change as we grow older?

- Rate may be slower

- Minimal impact on drug therapy

How does distribution change as we grow older?

- Increased body fat increases lipophilic drug distribution

- Increased concentration of hydrophilic drugs in blood

- Decreased albumin increases pharmacological effect

How does metabolism change as we grow older?

- Decreased liver size increases pharmacological effect

- Decreased Cytochrome p450 increases half-life

How does elimination change as we grow older?

Decreased renal function reduces secretion and reabsorption abilities.

What is the most significant pharmacokinetic change affecting medication response in older adults?

Elimination.

3 multiple choice options

What is the best marker of GFR?

Serum creatinine (SCr).

Serum creatinine is an unreliable indicator of kidney function in older adults (True/False).

True

1 multiple choice option

What is creatinine clearance (CrCl)?

An estimate of the kidney's abilities to excrete creatinine.

Creatinine clearance is a good way of predicting drug elimination in older adults (True/False).

True

1 multiple choice option

What are significant cardiovascular changes that affects pharmacodynamics in older adults?

- Decreased baroreceptor reflex increases orthostatic hypotension

- Stiffer blood vessels increases systolic hypertension

- Increased sensitivity to QT-prolongation

What are significant neurological changes that affects pharmacodynamics in older adults?

- Decreased number of cholinergic neurons increases sensitivity to anticholinergic drugs

- Increased permeability of the BBB increases risk for adverse CNS

What is the general rule when starting medications with older adults?

Start low and go slow.

3 multiple choice options

Having >3 conditions increases risk of death, disability, and adverse drug reactions in older adults (True/False).

True

1 multiple choice option

What are three criteria developed to increase awareness of drugs that may be inappropriate for older adults?

- BEERS Criteria

- STOPP/START Criteria

- FORTA

What is the biggest risk factor for adverse drug reactions in older adults?

The amount of medication being taken.

What are the 5 sections of the BEERS Critreria?

- Medications generally considered inappropriate for older adults

- Medications inappropriate for older adults with certain medical conditions

- Medications to be used cautiously in older adults

- Clinically important drug-drug interactions

- Medications to avoid or dose-adjust in renal impairment

What are some examples of drug classes that are potentially inappropriate for use with older adults?

- Antihistamines

- Benzodiazepines

- Digoxin

- Muscle relaxants

- NSAIDs

- Opioids

- Antipsychotics

- Tricyclic antidepressants

Opioids are considered to be a 3rd line medication for pain management with older adults (True/False).

True

1 multiple choice option

Opioids carry more risk of end-organ damage compared to NSAIDs (True/False).

False

1 multiple choice option

Opioid poisoning occurs when an opioid is taken as prescribed and results in harm (True/False).

False

1 multiple choice option

Opioid use disorder occurs when a mental health or behavioural disorder is attributable to the use of opioids (True/False).

True

1 multiple choice option

Adverse drug reactions occur when opioids are taken incorrectly and results in harm (True/False).

False

1 multiple choice option

What is another possible significant effect of opioids in older adults apart from respiratory depression?

Constipation.