Geriatrics (Final): Week 4

1.Many have multiple chronic medical conditions

2.They use multiple medications -polypharmacy

3.They receive prescriptions from different healthcare professionals making it difficult to track medications

4.Increased sensitivity, age-related and disease related changes

5.Adherence to medication plans

6.Cost very important

7.Underrepresented in clinical trials

What are some of the challenges of prescribing for older adults:

1

90% of older adults take more than __ medication

5

40% of older adults take more than __ medication

10

12% of older adults take more than __ medication

Five or more medications daily AND/OR

•Prescribing more medications than necessary

•Inappropriate medications

•Inappropriate length of time

What is the definition of polypharmacy?

•cognitive impairment

•falls, hip fractures

•urinary incontinence

•disability

•delirium

Geriatric Syndrome:

- over age 80

- > 6 chronic disease states

- > 9 medications and 12 doses per day

- having multiple providers

- impaired memory/alertness

•Low body weight / BMI < 18.5

•Creatine clearance < 50mL/min

ID some risks for difficulty in Medication management:

-Less body water

-More fat

-Less muscle mass

-Decreased hepatic metabolism

-Decreased renal excretion

-Decreased responsiveness of the baroreceptor reflex

what are some normal age related physiological changes:

•Impaired cardiac output

•Decreased drug clearance

•Diminished neurotransmitters

•Impaired cerebral blood flow

what are some normal disease related physiological changes:

Absorption

Which one is NOT affected by normal aging:

- Absorption

- Distribution

- Metabolism/Liver

- Excretion/Kidney

Excretion/Kidney

Which one is MOST significantly affected by normal aging:

- Absorption

- Distribution

- Metabolism/Liver

- Excretion/Kidney

Pharmacokinetics

what the body does to the drug:

Pharmacodynamics

what the drug does to the body:

•Decrease in the number of drug receptors

•Decreased affinity to receptor sites - lock and key mechanism

What are the age related changes that affect Pharmacodynamics?

•tricyclic antidepressants.

•antihistamines.

•Antimuscarinics (overactive bladders)

•Muscle relaxants

Most common anticholinergic drug classes used by the elderly:

Narrowing of Therapeutic Window

Drug toxicity may develop for drug doses that are in the therapeutic range for the average younger adult due to a ______

Adverse Drug Event (ADE)

An unexpected medical problem that happens during treatment with a drug or other therapy:

Adverse Drug Event (ADE)

What is the most common form of iatrogenic illness in the elderly?

7

Older adults are _____x more likely to experience adverse events

warfarin, insulin, digoxin

What 3 drugs are commonly associated with preventable adverse drug-related hospital admissions:

•Falls -fractures

•Orthostatic hypotension

•Xerostomia - top 500 medications

•Abnormal bleeding

What are the 4 Most common drug side effects in the elderly:

- cost

- Unpleasant Side Effects

- Forgetfulness

Top 3 most common factors for medication non-adherence:

•Starting a medication

•Taking a medication

•Adding a medication

•Reviewing a medication

•Stopping a medication

5 key moments to prevent an incorrect use of medication:

1.medications to be avoided in most older patients,

2.medications to be avoided with certain conditions,

3.medications that should be used with caution because the risks outweigh the benefits,

4.medication interactions,

5.and changes in dosing based on kidney function

The Beers criteria is a consensus-based list of Potentially Inappropriate Medications (PIM) for older adults:

- garlic

- ginger

- gingko

- ginseng

- green tea

These herbal agents have antiplatelet and anticoagulant properties and cause increased bleeding:

Ginseng

-may decrease the effectiveness of Warfarin and increase the risk of blood clots

-may also affect blood pressure and diabetic medication like oral hypoglycemics and insulin

-can elevate blood levels of digoxin by as much as 75

Kava

-Buprenorphine and ____ can lead to serious side effects such as respiratory distress, coma or even death

-May cause liver problems especially when taken with alcohol

Valerian

- May increase drowsiness and dizziness especially when combined with muscle relaxants, sleep or anxiety medications, opioids and antidepressants

grapefruit

this food interacts with STATINS (Simvastatin, Lovastatin) and CALCIUM CHANNEL BLOCKERS (Amlodipine) by:

•Increases the potency

•Higher blood levels of the drug

cranberries

this food interacts with Warfarin by Counteracting the anticlotting action and leads to bruising or bleeding:

bananas

this food interacts with ACE inhibitors by causing irregular heartbeats and heart palpitations due to too much potassium:

dairy

this food interacts with antibiotics (Tetracycline, Doxycycline, Cipro) by delaying or prevents absorption:

food in general

this food interacts with Penicillin VK by decreasing its absorption:

alchohol

this food interacts with acetaminophen by increasing liver toxicity:

Melatonin

_______ causes drowsiness, and should be avoided when prescribing an opioid analgesics

tetracycline, doxycycline, or cipro

These antibiotics will be ineffective with products that contains calcium, magnesium, zinc, iron or aluminum:

0.04

Cardiovascular disease the dose of epinephrine should be limited to a maximum of ____ mg.

•Use long-acting agents with caution

•Vasoconstrictors generally OK

•Make sure to aspirate

•No more than 2-3 carpules per visit

•Warn of lip and tongue - chewing in patients with dementia

What are some considerations for using LA on older patients:

Acetaminophen

What is the first line in treating mild to moderate tooth pain in older adults because of its safety compared to other analgesics:

NSAIDs

What analgesic should be used on older patients with Sharp, aching, or throbbing pain that do not have hx of GI bleeding, CHF, or renal disease?

Naproxen

____ is the NSAID used with patients at risk for cardiovascular disease

Celebrex

______ is the NSAID used with patients at risk for GI bleeding:

- GI bleeding

- renal disease

- cardiovascular disease

- severe asthma

Patient with what conditions should used NSAIDS with extreme caution:

NSAIDs

An older patient that presented to the Tufts with dental pain. History of congestive heart failure and high blood pressure.

Taking a number of medications (a diuretic, a beta-blocker, and an ACE inhibitor)

She was given ________ for its combined anti inflammatory and analgesic effect. They failed to consider the side effect in older adults with a hx of cardiovascular disease.

-this lead to sodium and water retention/ edema in her feet and caused worsening other congestive heart failure and blood pressure

Acetaminophen with Codeine (Tylenol #3)

What analgesic should be used on older patients with Moderate to severe pain?

3-7

•The ideal duration of antibiotic treatment is the shortest cycle capable of preventing both clinical and microbiological relapse.

•Most acute infections are resolved within ____ days

alcohol

_______ is the substance most commonly abused by seniors.

•Male (for alcohol)

•Female (prescription drugs)

•Grief

•Forced or unexpected retirement

•Changes in living arrangements

•Living alone

•Social isolation, loneliness

•Lack of support

Physical Risk factors for substance abuse include:

true

t/f: Hospitalized as often for alcohol-related problems as they are for heart attacks

60

Alcohol contributes to ___% of FALLS

Black men

______ were particularly affected by the increase in opioid overdoses, especially with the introduction of Fentanyl

true

t/f: Older adults take multiple prescription drugs, the chances of drug interactions are even higher when they abuse opioids

•Excessive sedation

•Respiratory depression

•Impaired vision, attention, and coordination

•Confusion

•FALLS

•Toxicity

•Overdose

HEALTH RISKS OF OPIOID USE:

opioids and benzodiazepines

The prescription drugs most commonly abused are:

pain

The number one reason older adults seek medical attention is ___

blood pressure

Marijuana is known to cause elevated ________

4

there is a __-time increase in the risk for heart attack after the first hour of smoking marijuana.

12

For Cannabis cease use at least __ hours before surgery

4

For CBD cease use at least __ hours before surgery