VCU DPT - Lifespan 2 (Geropharmacology)

what are the five M's that define geriatric healthcare professional's focus

Multicomplexity

Mind

Mobility

Medications

what Matters mosts

what are some things to consider with health care professionals for the...

Mind

mentation

dementia

delirium

depression

what are some things to consider with health care professionals for the...

Mobility

function

imapired gait, balance

fall injury

what are some things to consider with health care professionals for the...

Medications

polypharm

optimal prescribing

adverse medication effects

what are some things to consider with health care professionals for the...

what Matters Most

each individual's own meaningful health care outcome goals

what are some things to consider with health care professionals for the...

Multicomplexity

the whole person should be considered

- living with chronic conditions, illness, complication biopsychosocial needs

do a majority of older adults take at least one prescription medicine

yes

does 1/3 of adults take 5 or more prescription meds?

YES

- this is the technical definition of polypharmacy

do majority of older adults take dietary supplements

yes

difference in pharmacokinetics and pharmacodynamics

pharmacokinetics: what the body does with the drug

pharmacodynamics: what the drug does to the body

________ is what the body does to the drug

pharmacokinetics

__________ is what the drug does to the body

pharmacodynamics

absorption, distribution, metabolism, excretion

pharmacokinetics, or pharmacodyanmics?

pharmacokinetics

therapeutic/toxic response

pharmacokinetics, or pharmacodyanmics?

pharmacodynamics

what are age related changes impacting:

absorption

and this impact on the DRUG

slower stomach emptying and gut movement, plus less acid makes drugs dissolve slower

absorption does not decline a ton, but if drug needs acid it may

what are age related changes impacting:

distribution

and this impact on the DRUG

higher body fat and less lean muscle/water

if they can go in fat, may last longer. and if go in water, concentrated

what are age related changes impacting:

metabolism

and this impact on the DRUG

live size and blood floow decreases, enzyme activity is less

drugs are cleared slower, and the effects last longer

what are age related changes impacting:

excretion

and this impact on the DRUG

kidney blood flow and filtration declines

drugs eliminated by kidneys accumulates, higher toxicity risk

what are some pharmacodynamic changes with age

what are the impacts on them

receptor responsiveness, homeostatic regulation all change

there is less physiologic reserve, and impaired baseline performance

higher sensitivity to sedation/impairments with benzos

higher level and duration of pain relief with opiods

higher drowsiness with alcohol

higher senstivity to anticholinergic agents

decreased HR response to beta blockers

these are all examples of changes with _________________

pharmacodynamics

drug affects body differently bc body more sensitive

which word is better

- adherence

- compliance

WHY

adherence

- illustrates that the patient is wanting to/agreeing to this exchange

does adherence change when there are more drugs?

yes it gets worse

what is adherence vs persistance in terms of taking drugs

persistance is the duration you take it

adherence is the fact if you take it or not

how is persistance of drug usage the longer you take it

it gets worse

forgetting to take drugs

patient believing drug isnot needed

difficulty taking drugs

cost

these are allWHAT

barrier to taking drug

when you add more drugs, is patient at higher risk of adverse effect

yes

older patients taking 6 or more drugs are twice as likely to experience ____________

delirium

are older adults at higher risk for falls if they take multiple drugs

yes

are older adults taking high amounts of drugs at higher chance of death

yes

when is polypharmacy appropriate

if rx of multiple medicines is rational and based on current evidence and considering the patiet factors and context

when is polypharmacy inappropriate

irrational prescribing of too many medicines

t/f: polypharm can be beneficial or harmful

t

describe the prescribing cascade

drug 1 has a side effect, considered a sx

drug 2 is given for drug 1 side effect, and this drug has a side effect that is considered a sx

drug 3 is given for side effect of drug 2, and this drug has side effect

etc, etc

taking of NSAIDs leads to increased blood pressure, which then results in antihypertensive therapy

what is this an example of

prescribing cascade

medication management is a ______________ act

balancing

any new symptom in an older adult should be considered a ________ until proven otherwise

drug side effect

- this instead of sx, to help avoid over prescribing

describe the C.L.E.A.R. symptoms of medication related problems

Cogntiive loss

Loss of bladder/bowel

Eating/appetite changes

Activity or energy changes

Recurrent falls

Anticholinergic effects are caused by drugs that block action of __________

acetylcholine

a messenger released by nerve cell to transmit a signal to neighboring nerve cell

t/f: anticholinergics and symptoms medications are given have a lot of overlap

true

what are the 7 steps to appropriate polypharmacy

aim: what matters to person

need: identify essential drug therapy

not needed: does person take unnecessary therapy

effectiveness: are therapeutic objectives being achieved

safety: is person at risk for adverse drug reactions

sustainability: is the therapy cost effective and enviro sustainable

patient centered: is the person willing and able to take therapy as intended

what is a system that can be used for assessing appropriate med use

beers criteria

beers is organized into 5 tables:

1. Potentially inappropriate medications, organized according to ____ system

2. PIMs for older adults due to _____________ disease that might exacerbate disease

3. PIMs used with ___________

4. potentially cliinically important drug-drug interactions that should be __________

5. meds that by itself should be ___________

1. organ

2. drug

3. caution

4. avoided

5. avoided

what is an example of anticholinergic

diphenhydramine

what are some practical applications of beers criteria (4)

knowing drug quality

education for your or patient

research

clinical practice help

what is deprescribing

the systematic process of identifying and discontinuing/reducing the dose of medications

when do you consider deprescribing

when the drugs have clear harms

when there are uncertain benefits to the drugs

if there is a prescribing cascade

sometimes patients can be _________dosed, leading to

- depression/cognition

- pain management

- respiratory function

- exercise capacity

- fracture risk reduction

impacts that can be improved

UNDER

what is our role as PTs with geropharm (3)

observe and screen

assess

report

who might be an appropriate candidate to screen (4)

risky meds/cnditions

multiple prescribers

infrequent monitoring

kidney/liver dysfn

what 5 main symptoms are we looking at that could be an adverse drug efffect

cognitive changes

loss of bladder and bowel

eating or appetite changes

activity or energy changes

recurrent falls

when you should report if you think there is an issue

ANY TIME you are concerned

what are some things that heighten your cocnern

recent changes

their progress is impeded

they are in clear danger