Special Pops Lectures 15 and 16: Geriatrics | Quizlet

What is the mean prevalence of ADRs in the elderly?

11%

Polypharmacy

regular use of 5 or more medications (Rx, OTC, or herbal) on a daily basis

Why is polypharmacy an issue in the elderly?

higher prevalence of chronic diseases and comorbidities that place them at higher risk of ADRs

What medications pose higher risk of ADRs in the elderly?

Antithrombotics/ Anticoagulants

Antidiabetic medications (insulin, sulfonylureas)

Opioids

How does absorption and first-pass metabolism change in the elderly?

Unchanged absorption

Reduced FPM

How does volume of distribution metabolism change in the elderly?

increased body fat and decreased body water

How does protein binding metabolism change in the elderly?

lower serum albumin - increased free concentraions of protein bound drugs

How does metabolism metabolism change in the elderly?

reduced oxidative metabolism and unchanged conjugative metabolism

How does excretion metabolism change in the elderly?

reduced with decreased GFR and tubular excretion

Most medications are absorbed by passive diffusion ________________ significant age-related changes.

without

Lipid soluble medications have an __________ half-life in older adults.

increased

Highly-albumin-bound drugs have __________ fraction of free drug.

increased

What benzodiazepines can be used in elderly patients? Why?

Lorazepam

Oxazepam

Temazepam

dependent on Phase 2 metabolism that is not affected by age changes

Older adults have decreased sensitivity to what medications?

Beta-blockers

Beta-agonists

___ of ADRs in older adults are due to inappropriate prescribing.

50%

What are the principles of appropriate prescribing in the elderly?

Start low and go slow

Start one at a time

Use old meds rather than new

Quality of life vs mortality benefit

Medications monitoring

What is the prescribing cascade?

starts when an ADR is misinterpreted as a new medical condition where a new medication is prescribed and repeats

What are some strategies to minimize the prescribing cascade?

Prevention

Detection

Reverse

Deprescribing

process of identifying and D/C-ing drugs in instances which existing or potential harms outweigh existing or potential benefits within the context of a patient's care goals

What are the goals of deprescribing?

improve health outcomes

Reduce medication burden

Reduce falls

Decrease hospitalizations and death

Decrease costs

Improve QoL

What are the steps of deprescribing?

1. Review all of the patients medications

2. Talk to the patient about the process

3. Deprescribe medications (one at a time)

4. Create a follow-up plan

Who is the target for deprescribing?

Polypharmacy

Multimorbidity

Renal impairment

Dementia

Nonadherence

Multiple prescribers

What medications should we consider deprescribing in the eldery?

Anticholinergics

BZDs

Sulfonylreas (long acting)

Insulins

PPIs

NSAIDs

Beer's Criteria

used to assist in preventing ADEs in older adults in the inpatient/outpatient setting

Starting and stopping medications in the elderly should be done how?

one at a time

What does START stand for?

Screening Tool to Alert Doctors to Right Treatment

What does STOPP stand for?

Screening Tool of Older Person's potentially inappropriate Prescriptions

What are the barriers to deprescribing?

Patient/family reluctance

Limited time

Lack of evidence

Multiple providers

Clinical inertia

What are the medication related risk factors for falls?

Polypharmacy

Low BP

UTIs

Low sodium and glucose levels

What medication should be used for glucose control in older adults?

Metformin