L3 Intro to Geriatrics

Identify medical conditions that commonly occur in
the elderly

Frailty, falls, delirium

Recognize age related changes that can affect
pharmacokinetics and pharmacodynamics related to medication use in the elderly.

Pharmacodynamics

Altered drug response- “sensitivity”
 Changes in concentration of drug at the receptor
 Change in the receptor numbers
 Changes in receptor affinity
 Post-receptor alterations
 Age related impairment of homeostatic mechanisms

Most effects seen in CNS or cardiovascular meds

List ways to enhance health related quality of life in
the elderly population

Eating healthy
Appropriate nutrition
Physical activity
Social interactions/ groups
Be aware of transportation and other resources in your area

Identify factors leading to adverse drug reactions
(ADR) in the elderly

More than $520 billion was spent for prescription associated morbidity and mortality from non-
optimized medications in 2016.
9% of hospitalizations in the elderly are due to ADR
Risk factors affecting adverse drug reactions
 Health care transitions
 Some medication/classes have a higher risk of ADR (ex. Anticoagulants, opioids)
 Number of medications (Polypharmacy)
 Frailty of patient
 Underuse of medications
 Poor adherence

Define polypharmacy, medication underuse, and
adherence as related to potential medication
related problems

Polypharmacy: Defined as prescription, administration, or use of more medications than are clinically indicated or necessary.
• Not necessarily defined by a specific number of medications.
• Leads to unnecessary costs to the patient and health care system (5 or more meds)

Medication underuse: Clinical indication without medication
 Undertreatment of a medical condition
 Examples: antihypertensives, anticoagulants, lipid-lowering agents, bronchodilators not
being used in patients that would benefit

NonAdherence: A patient is not taking the medication regimen as prescribed

Describe how to use the Beer’s Criteria, START, and STOPP criteria for assessment medication regimens in elderly patients

Beer’s Criteria: used in the US- developed by AGS (American Geriatrics Society)
 Criteria are organized into 5 sections
 Medications that are potentially inappropriate, meds that are potentially
inappropriate in certain conditions, meds to be used with caution, potentially
inappropriate drug-drug interactions, and meds whose doses should be adjusted
based on renal function

Describe how to use the Beer’s Criteria, START, and STOPP criteria for assessment medication regimens in elderly patients

STOPP- used in the UK
 Include drugs to avoid, dosing considerations, drug-disease interactions and
decreased renal function
 Organized based on physiological system
 11 sections

Hepatic metabolism

Liver is responsible for drug metabolism

-Phase 1 oxidation

-Phase 2 conjugation

What affects hepatic metabolism?

Liver perfusion

Capacity of drug metabolizing enzymes

Transfer of drug into hepatocyte from blood

Protein binding

Risk factors affecting adverse drug reactions

Health care transitions

Some medication/classes have a higher risk of ADR

Number of medications

Frailty of patient

Underuse of medications

Poor adherence

Clinical inertia

suboptimal control of a disease state (worried about starting a new medication, changing a dosing, etc)

Potentially inappropriate medications (PIM)

Shows red flags of medication in the elderly, which ones to use versus which ones to avoid

Deprescribing

Planned dose reduction or discontinuation of medications that cause harm or are not providing benefit

Individualized