Geriatrics – ADM 1015: Special Populations

Question-and-answer flashcards covering key concepts, definitions, physiologic changes, pharmacokinetic and pharmacodynamic considerations, atypical presentations, and medication safety tools relevant to geriatric pharmacotherapy.

At what age does Medicare and Social Security generally define someone as geriatric?

65 years and older

How are the "youngest old" age-group classified?

65–74 years old

List the five leading causes of death in the U.S. geriatric population.

Heart disease, cancer, Alzheimer’s disease, cerebrovascular disease, chronic lower respiratory disease

What does the acronym ADLs stand for and give two examples.

Activities of Daily Living; examples: bathing, dressing

Give two examples of Instrumental Activities of Daily Living (IADLs).

Managing money, preparing meals

Define disability in the geriatric assessment context.

Limitation in ADLs, IADLs, or significant mobility problems

What federally funded program provides comprehensive care to frail community-dwelling elders aged ≥55?

PACE – Program of All-Inclusive Care for the Elderly

What is polypharmacy typically defined as?

Concurrent use of five or more medications

Name three common adverse drug events (ADEs) in older adults.

Confusion, falls, dizziness (others acceptable: delirium, incontinence, etc.)

According to J. Gurwitz, how should any new symptom in an elderly patient be initially considered?

As a potential drug side effect until proven otherwise

What serum albumin level suggests protein-calorie malnutrition in elders?

< 3.5 g/dL

List the five criteria that may define frailty; how many are required for diagnosis?

Unintentional weight loss, muscle weakness, physical slowness, poor endurance/exhaustion, low physical activity; at least 3 of 5 required

Give two atypical presentations of acute myocardial infarction (AMI) in the elderly.

Weakness or confusion (other acceptable: syncope, abdominal pain)

What pharmacokinetic change is primarily responsible for increased bioavailability of high first-pass drugs in elders?

Decreased first-pass metabolism

Which equation is recommended to estimate creatinine clearance for drug dosing in older adults?

Cockcroft–Gault equation

State one physiologic reason why lipophilic drugs have a larger volume of distribution in older adults.

Increased body fat percentage

Name two high-extraction drugs whose metabolism declines 35–55 % with aging.

Amitriptyline and morphine (others: fentanyl, metoprolol)

Why are older adults more sensitive to central nervous system drug effects?

Altered neurotransmitter systems and increased blood–brain barrier permeability

Which sensory loss contributes to safety risks such as falls in older adults: high-pitch hearing or low-pitch hearing?

High-pitch, high-frequency hearing loss

Identify two key goals that often guide treatment plans for geriatric patients.

Maintaining independence and preventing institutionalization

What is the purpose of the Medication Appropriateness Index (MAI)?

Systematically assesses each drug for indication, effectiveness, safety, practicality, and cost

What do the letters in START criteria stand for?

Screening Tool to Alert doctors to Right Treatment

Which tool lists potentially inappropriate prescriptions in elders: STOPP or START?

STOPP

Give one example of a medication class flagged by START as often under-prescribed after myocardial infarction.

ACE inhibitor or beta blocker (either acceptable)

According to STOPP, why should long-term benzodiazepines generally be avoided in elders?

They increase risk of sedation, cognitive impairment, falls, and fractures

What year did the American Geriatrics Society assume stewardship of the Beers Criteria?

2011

List three drug categories with strong anticholinergic properties that Beers says to avoid.

First-generation antihistamines, tricyclic antidepressants, antispasmodics

State four classic signs of anticholinergic toxicity.

Mad as a hatter (confusion), blind as a bat (blurred vision), dry as a bone (dry mouth/urinary retention), red as a beet (flushing) – plus hot as a desert (hyperthermia)

Which cardiovascular drug is singled out in Beers as poor first-line therapy for atrial fibrillation or CHF due to toxicity concerns?

Digoxin (doses > 0.125 mg/day)

Name the mnemonic "LOT" for preferred benzodiazepines in older adults.

Lorazepam, Oxazepam, Temazepam

Why should proton pump inhibitors generally be limited to ≤8 weeks in elders?

Prolonged use increases risk of Clostridioides difficile infection and bone fractures

Which sulfonylureas are discouraged in older adults due to prolonged hypoglycemia?

Glyburide and glimepiride

What combination of agents markedly increases overdose risk and is advised against by Beers?

Opioids plus benzodiazepines

Below what CrCl should rivaroxaban be avoided according to Beers renal guidance?

Which two anticoagulants have higher GI bleed risk than apixaban in patients ≥75 years?

Dabigatran and rivaroxaban

According to Beers, when are antipsychotics acceptable in dementia patients?

Only when non-pharmacologic measures fail and the patient poses harm or has severe distress

What physiologic change leads to increased orthostatic hypotension risk in elders?

Reduced baroreceptor activity

Name three risk factors for adverse drug reactions specific to older adults.

Polypharmacy, multiple comorbidities, impaired renal/hepatic function

Give one example of a drug–disease interaction Beers advises avoiding in Parkinson’s disease.

Metoclopramide (also acceptable: promethazine, typical antipsychotics)

What is the recommended management for NSAID use in an elder with a history of peptic ulcer disease if an NSAID is absolutely necessary?

Co-prescribe a gastroprotective agent such as a PPI or misoprostol

Which assessment term describes the body’s ability to withstand stress and maintain function that declines with age?

Functional reserve capacity

What core question should be asked to screen for medication adherence problems?

"How often do you miss your medications?" asked in a non-threatening manner

Which analgesic opioid is discouraged in elders due to neurotoxicity and delirium risk, especially in CKD?

Meperidine

Why does decreased albumin in seniors affect phenytoin dosing?

Lower albumin increases unbound (active) phenytoin concentrations

Which physiologic change results in higher peak levels and prolonged half-life for water-soluble drugs in elders?

Decreased total body water

What is the main clinical consequence of decreased renal tubular secretion in aging?

Prolonged elimination half-life of renally cleared drugs

State one non-pharmacologic intervention strongly recommended to treat frailty.

Exercise and strength training

List two care environments besides hospitals where elders commonly receive care.

Assisted living facilities and long-term care (nursing homes)

Give an example of a START recommendation for chronic atrial fibrillation.

Initiate warfarin or antiplatelet therapy if not contraindicated

Which OTC antihistamine found on Wilma Wobbles’ list violates Beers Criteria and why?

Diphenhydramine – strong anticholinergic causing sedation and confusion

What Beers recommendation applies to rivaroxaban dosing when CrCl is ~40 mL/min?

Reduce the dose rather than use full 20 mg daily

According to Beers, which drug combination should be avoided due to high bleeding risk without GI protection?

Aspirin plus warfarin without a PPI

Which MAI question evaluates whether directions are feasible for the patient to follow?

"Are the directions practical?"

Provide an example of a prescribing cascade.

NSAID causes hypertension → antihypertensive added instead of stopping NSAID

What is the first pharmacokinetic phase usually unaffected by normal aging for most passively absorbed drugs?

Absorption (via passive diffusion)

Explain why high-protein binding displacement can be clinically significant in elders.

Increased free drug leads to enhanced pharmacologic and toxic effects

Which frailty prevalence figure is correct for adults ≥80 years: 7 % or 20 %?

20 %

Identify a drug whose prodrug activation may decrease in elders due to reduced first-pass metabolism.

Clopidogrel (also acceptable: most ACE inhibitors except lisinopril/captopril)

Why are first-generation calcium channel blockers like nifedipine IR discouraged as antihypertensives in elders?

Risk of reflex hypotension and myocardial ischemia

What must accompany opioid therapy >2 weeks in elders to satisfy STOPP criteria?

A bowel regimen to prevent constipation

Which common elderly physiologic change increases residual lung volume and reduces vital capacity?

Decreased respiratory muscle strength and chest wall compliance

Name two endocrine changes of aging that can influence drug response.

Reduced estrogen/testosterone and altered insulin signaling

What tool can be used to verify a patient’s actual medication fills and detect nonadherence?

Pharmacy medication fill history or Prescription Drug Monitoring Program (PDMP)

What high-risk drug interaction is created by adding ACEI + ARB + spironolactone?

Severe hyperkalemia

Give one example of a medication where transdermal absorption can be altered due to skin thinning.

Fentanyl patches