Geriatric Medications - Week 2

The study of drugs and how they interact with the body, including therapeutic effects and unwanted effects.

A. Pharmacology

B. Pharmacokinetics

C. Pharmacodynamics

Pharmacology

What the drug does to the body. Including drug's effects on the body and how it acts at the cellular/receptor level.

A. Pharmacology

B. Pharmacokinetics

C. Pharmacodynamics

Pharmacodynamics

What the body does to the drug. It includes absorption, distribution, metabolism, and excretion.

A. Pharmacology

B. Pharmacokinetics

C. Pharmacodynamics

Pharmacokinetics

How the drug enters the bloodstream

A. Absorption

B. Distribution

C. Metabolism

D. Excretion

Absorption

How the drug spreads through the body

A. Absorption

B. Distribution

C. Metabolism

D. Excretion

Distribution

How the drug is chemically changed/broke down, primarily by the liver

A. Absorption

B. Distribution

C. Metabolism

D. Excretion

Metabolism

How the drug and its metabolites are removed, primarily by the kidneys

A. Absorption

B. Distribution

C. Metabolism

D. Excretion

Excretion

Toxicity:

A. The time required for 50% of the drug remaining in the body to be eliminated

B. The range of drug doses or concentrations that produces the desired therapeutic effect without causing adverse or toxic effects

C. An unintended effect of a medication that occurs in addition to its desired therapeutic effect

D. An unwanted and potentially harmful effect caused by a drug when give at the recommended dosage

C. Harmful effects that occur when a drug reaches excessively high levels in the body

Harmful effects that occur when a drug reaches excessively high levels in the body

Half-life:

A. The time required for 50% of the drug remaining in the body to be eliminated

B. The range of drug doses or concentrations that produces the desired therapeutic effect without causing adverse or toxic effects

C. An unintended effect of a medication that occurs in addition to its desired therapeutic effect

D. An unwanted and potentially harmful effect caused by a drug when give at the recommended dosage

C. Harmful effects that occur when a drug reaches excessively high levels in the body

The time required for 50% of the drug remaining in the body to be eliminated

Therapeutic index/range:

A. The time required for 50% of the drug remaining in the body to be eliminated

B. The range of drug doses or concentrations that produces the desired therapeutic effect without causing adverse or toxic effects

C. An unintended effect of a medication that occurs in addition to its desired therapeutic effect

D. An unwanted and potentially harmful effect caused by a drug when give at the recommended dosage

C. Harmful effects that occur when a drug reaches excessively high levels in the body

The range of drug doses or concentrations that produce the desired therapeutic effect without causing adverse or toxic effects

Adverse effect:

A. The time required for 50% of the drug remaining in the body to be eliminated

B. The range of drug doses or concentrations that produces the desired therapeutic effect without causing adverse or toxic effects

C. An unintended effect of a medication that occurs in addition to its desired therapeutic effect

D. An unwanted and potentially harmful effect caused by a drug when given at the recommended dosage

C. Harmful effects that occur when a drug reaches excessively high levels in the body

An unwanted and potentially harmful effect caused by a drug when given at the recommended dosage

Side effect:

A. The time required for 50% of the drug remaining in the body to be eliminated

B. The range of drug doses or concentrations that produces the desired therapeutic effect without causing adverse or toxic effects

C. An unintended effect of a medication that occurs in addition to its desired therapeutic effect

D. An unwanted and potentially harmful effect caused by a drug when give at the recommended dosage

C. Harmful effects that occur when a drug reaches excessively high levels in the body

An unintended effect of a medication that occurs in addition to its desired therapeutic effect

As we age...

changes in GI function such as

↓ gastric acid

↓ absorbing area

↓ stomach acid

↓ stomach emptying

This affects what part of pharmacokinetics?

Absorption

As we age...

↓ total body water

↓ lean body mass

↑ body fat

↓ plasma proteins

This affects what part of pharmacokinetics?

Distribution

As we age...

↓ liver mass

↓ liver blood flow

↓ activity of drug-metabolizing enzymes

This affects what part of pharmacokinetics?

Metabolism

As we age... *Most important changes*

↓ kidney blood flow

↓ kidney mass

↓ renal tubular function in nephron

This affects what part of pharmacokinetics?

Excretion

True or false: Aging alters pharmacodynamics, as the body becomes more or less sensitive/responsive to certain drugs.

True

Medication is taken by mouth and absorbed through the gastrointestinal tract:

A. Oral

B. Sublingual

C. Topical

D. Nasogastric

E. Parenteral

F. Inhalation

G. Rectal

Oral

Medication is placed under the tongue, where it dissolves and is absorbed through the mucous membranes:

A. Oral

B. Sublingual

C. Topical

D. Nasogastric

E. Parenteral

F. Inhalation

G. Rectal

Sublingual

Applied directly to the skin nor mucous membranes:

A. Oral

B. Sublingual

C. Topical

D. Nasogastric

E. Parenteral

F. Inhalation

G. Rectal

Topical

True or false: Transdermal medication is delivered through the skin into the bloodstream, often through a patch that slowly releases medications over time.

True

Administered through a tube inserted through the nose into the GI tract, such as stomach:

A. Oral

B. Sublingual

C. Topical

D. Nasogastric

E. Parenteral

F. Inhalation

G. Rectal

Nasogastric

breathed into the respiratory tract as a gas, liquid mist, or powder and can be absorbed through the lungs:

A. Oral

B. Sublingual

C. Topical

D. Nasogastric

E. Parenteral

F. Inhalation

G. Rectal

Inhalation

Medication is placed into the rectum for absorption. Useful when oral is difficult, such as vomiting or difficulty swallowing:

A. Oral

B. Sublingual

C. Topical

D. Nasogastric

E. Parenteral

F. Inhalation

G. Rectal

Rectal

Nonoral route, typically by injection. Such as SC, IM, IV:

A. Oral

B. Sublingual

C. Topical

D. Nasogastric

E. Parenteral

F. Inhalation

G. Rectal

Parenteral

Injection into subcutaneous tissue beneath the skin; example: insulin.

A. Subcutaneous

B. Intramuscular

C. Intravenous

Subcutaneous

Injection into the belly of a large muscle.

A. Subcutaneous

B. Intramuscular

C. Intravenous

Intramuscular

Medication administered directly into a vein. It may be given continuously through an IV drip or as a single bolus dose.

A. Subcutaneous

B. Intramuscular

C. Intravenous

Intravenous

What is polypharmacy?

A. Taking medications only when symptoms occur

B. The excessive or inappropriate use of medications

C. Taking two medications at the same time

D. Using only over-the-counter medications

The excessive or inappropriate use of medications

What is something physical therapists should do to help limit the negative effects of polypharmacy in older adults?

A. Recommend that patients stop unnecessary medications

B. Perform a comprehensive medication reconciliation

C. Change medication dosages based on patient symptoms

D. Prescribe alternative medications

Perform a comprehensive medication reconciliation

Factors for adverse drug reactions:

1. C_______

2. Lack of proper drug t_____/regulations

3. Lack of patient e________

4. Lack of patient a_________

5. Use of inappropriate m_________ (Beers criteria)

6. Other factors (diet, OTC, smoking, caffeine, alcohol, and other substances)

1. Comorbidities

2. Lack of proper drug testing/administration

3. Lack of patient education

4. Lack of patient adherence

5. Use of inappropriate medications (Beers criteria)

6. Other factors (diet, OTC, smoking, caffeine, alcohol, and other substances)

What is the main effect of antipsychotics:

Brain, blood pressure, or blood sugar

Brain - sedation, confusion

What is the main effect of antidepressants (high risk from SSRIs)

Brain, blood pressure, or blood sugar

Brain - sedation, dizziness

What is the main effect of Antiepileptics:

Brain, blood pressure, or blood sugar

Brain - sedation, dizziness

What is the main effect of Hypnotics (Benzodiazepines):

Brain, blood pressure, or blood sugar

Brain - sedation, confusion

What is the main effect of Opiods:

Brain, blood pressure, or blood sugar

Brain - sedation, dizziness

What is the main effect of Cardiovascular meds (including loop diuretics):

Brain, blood pressure, or blood sugar

Blood pressure - orthostatic hypotension - dizziness/syncope

What is the main effect of Insulin:

Brain, blood pressure, or blood sugar

Blood sugar - hypoglycemia - dizziness/weakness

What is the main effect of Antihistamines:

Brain, blood pressure, or blood sugar

Brain - sedation, dizziness, confusion

What is the main effect of Anticholinergics/ overactive bladder drugs:

Brain, blood pressure, or blood sugar

Brain - confusion, dizziness, drowsiness

Fall Risk Increasing Drugs have what typical effects:

1. S___________

2. D__________

3. D__________

4. O_________ ________

1. Sedation

2. Dizziness

3. Drowsiness

4. Orthostatic hypotension

PT Implications for adverse drug interactions:

1. F____ risk

2. Distinguish s_______ vs. s_____ effects

3. Scheduling PT v____

4. E______ on medications

5. Education on c_______/adherence of drug regimens

6. A_______ and coordinating care with providers

1. Fall risk

2. Distinguish symptoms vs. side effects

3. Scheduling PT visits

4. Education on medications

5. Education on compliance/adherence of drug regimens

6. Advocating and coordinating care with providers