Geriatrics

Delay in gastric emptying (decreased motility) results in

Delay in med absorption

Decrease gastric acid secretion (less acidic environment) leads to

Meds needing acidic environments for absorption (so older patients should take with something acidic like soda)

Skin is drier and has decreased

Lipid content (which leads to variable transdermal med absorption)

Muscle mass and albumin is

Decreased

Meds that are highly protein bound become more unbound allowing them to be...

More readily available to act upon receptors resulting in increased pharmacological effect

Body fat is

Increased

Lipophilic meds have a shortened or prolonged half life?

Prolonged

Total body water is

Decreased

Hydrophilic meds require larger or smaller doses?

Smaller

Reduction in drug metabolism and excretion with age results in

Increased bioavailability (drug hangs around longer)

CrCl increases or decreases with age?

Decreases

Blood brain barrier increases or decreases permeability with age?

Increases (greater access of meds to CNS)

Anticholinergic meds have an increased effect with age due to these changes in the acetylcholine neurotransmitter system

Decrease Cl- uptake from the periphery

Decrease nicotine and muscarinic receptors

Decrease number of cholinergic receptors

AGS Beers criteria

Meds considered as potentially inappropriate in older adults

What happens to the effects of anticholinergics with age?

Clearance reduced

Increased sensitivity and risk of side effects

Side effects of anticholinergics

Confusion, dry mouth, dry eyes, constipation, delirium

Concerning CNS classes

Antidepressants

Antipsychotics

Benzodiazepines

Hypnotics

Highly anticholinergic, sedating, can cause orthostatic hypotension

Antidepressants

Risk of stroke and greater rate of cognitive decline

Increased risk of mortality in person with dementia - black box warning

Antipsychotics

Increased sensitivity and decreased metabolism

Risk of cognitive impairment, delirium, falls, fractures

Benzodiazepines

Risk of cognitive impairment, delirium, falls, fractures

Increased ED visits and hospitalizations

Hypnotics

Avoid meperidine and regular/high doses of...

Skeletal muscle relaxants

Meds that can exacerbate delirium and dementia

Anticholinergics, antipsychotics, benzodiazepines, hypnotics

Avoid opioids and benzodiazepines due to risk of

Overdose

Reduce number of CNS-active meds to reduce risk of

Falls and CNS effects

Take away points

One med at a time

Low dose and increase gradually

Monitor closely

Start low and go slow

PPIs (e.g. omeprazole, pantoprazole) - should assess for indications such as GERD and GI ulcers because associated with overgrowth of

C. Difficile that can cause diarrhea, inflammation of the colon, and potentially fatal

Use caution with BP meds such as xxx for HTN

alpha-1 blockers (e.g. prazosin) and alpha-2 agonists (e.g. clonidine)

NSAIDs (e.g. ibuprofen, naproxen) - increased risk of

GI bleed; can adverse impact kidney function