Geriatrics (Pharm Stuff)

meds that cause incontinence

- diuretics (increase production + frequency)

- anticholinergics (urinary retention => overflow)

- psychotropics

- opioids

- alpha blockers (women) (relax urethra => stress incontinence)

- alpha agonists (men)

- CCBs

meds for urge incontinence

- beta 3 agonists (mirabegron, vibegron)

- antimuscarinics (tolterodine, oxybutynin, festerodine, trospium, darifenacin, solifenacin)

meds for overflow incontinence (for men?)

- alpha blocker (terazosin, prazosin)

- ADD finasteride for enlarged prostate

monitor RENAL stuff if on...

- vancomycin

- digoxin

- enoxaparin

monitor LIVER stuff on...

- opioids

- warfarin

- phenytoin

- carbamazepine

bad meds for elderly

- sulfonylureas (seem to all start with g and end in -ide... glibenclamide, glypizide)

- NSAIDs that increase GI bleed risk (esp when combined w/ omeprazole (PPIs))

- beta blockers (switch if HTN)

things good to start in elderly...

- ACEi / ARBs (recommendation for HTN + DM, especially if CKD)

- statins

- calcium, vitamin D

- sitagliptin (DPP-4 inhibitor)

Tx for GU complaints

testosterone replacement = PDE5 inhibitors (Sildenafil) - C/I if also on nitroglycerine, nitrates (cause hypoTN, syncope)

vaginal estrogen therapy, moisturizers, Kegel exercises

drugs causing sexual dysfunction

cardiovascular:

- beta blockers

- diuretics

- ACEi/ARBs

- nitrates

- statins

alpha blockers:

- tamsulosin

psych meds:

- SSRIs

- benzos

- antipsychotics

hormonal therapies:

- glucocorticoids (prednisone)

- hormone replacement therapy

medications that can cause ED

- nitrates

- antiHTN

- antidepressants

- opioids

meds that cause falls

- sedatives /hypnotics

- antidepressants

- benzos

osteoporosis

give biphosphonates

pain management

preferable = PO

options:

- NSAIDs, Tylenol

- topical analgesics (lidocaine patch)

mild to moderate pain meds

- Tylenol (no more than 2 g/day in elderly, hepatotoxic risk)

- ASA

- NSAIDs (nephrotox risk, GI bleed risk that decreases w/ enteric coated pills, use of a PPI, lowest if COX-2?)

moderate to severe pain meds

short course of opioids for acute

cancer pain, pain from advanced illness can be treated with

opioids + interventional modalities

Celecixib / Celebrex

Cox-2, no effect on platelets

INCREASES risk of MI/stroke

diclofenac

comes in topical form w/ less GI bleed risk as well as systemic absorption risk

opiods

- metabolized by liver (elderly have more SE: delirium, falls, fractures, resp depression)

- excreted by kidneys (accumulation by decreased GFR can cause tox)

coprescribe w/ bowel regimen (senna, docusate, bisacodyl)

SE of opioids

- sedation

- constipation

- delirium

- resp depression

- N/V

- urinary retention

- hypotension

- pruritus

- myoclonus

- tolerance, dependence

acute pain options

- treat underlying

- NSAIDs

- Tylenol +/- NSAID

- PCA (pain controlled analgesia)

- opioids (short term)

dementia meds

- acetylcholinesterase inhibitors (donepezil, golantamine, rivastigmine)

- memantine

- MABs for AD

1st line antidepressant

SSRIs (sertraline, (es)citalopram)

bc they're safer for cardiac patients over TCAs

citalopram dose

>60 y, = 20mg PO qd bc of risk of dose-dependent QT prolongation

augmentation therapy in elderly depression

ADD:

- lithium

- methylphenidate

- aripiprazole

severe or catatonic depression

consider ECT

SSRI SE

- hyponatremia

- insomnia

- falls/fractures

- sexual dysfunction

- bleeding risk

- serotonin syndrome

- HA

- nausea

- tinnitus

don't add things that also cause these (common sense except also antiHTNs are C/I)

SNRI SE

- hypertension

- nausea

- constipation

- decreased appetite

- insomnia

- sedation

- dizziness, orthostatic hypotension

- hyponatremia

- sexual dysfunction

- urinary retention

- bleeding risk

- hepatotoxicity - C/I in liver disease, monitor LFTs

same C/Is as SSRIs + alcohol

serotonergic drugs that are C/I w/ risk of serotonin syndrome

SNRIs:

- tramadol

- linezolid

MAOIs (be more strict):

- that plus

- SSRIs

- SNRIs

- TCAs

- buproprion

monitor ___ w/ venlafaxine

monitor __ on duloxetine

v: BP

D: LFTs

TCA SE

- anticholinergic

- orthostatic hypotension

- cardiac conduction abnormalities (prolonged QTC, arrhythmias)

- sedation

- cognitive impairment

- weight gain

- photosensitivity

TCA C/I meds

- anticholinergics (antihistamines, bladder antispasmodics)

- antiarrythmics

- digoxin

- CNS depressants

- SSRIs/MAOIs

- clonidine

MAOI SE

- orthostatic hypotension

- HTN crisis

- insomnia, agitation, dizziness, tremor, confusion

- serotonin syndrome

- sexual dysfunction

- weight gain

- liver toxicity

MAOI CI

- serotonin things

- sympathomimetics (pseudoephedrine)

- meperidine, methadone, dextromethorphan

- tyramine rich foods (cured meats, aged cheeses, soy, red wine)

- CNS depressants

buproprion risks

- insomnia

- agitation

- weight loss

- seizure

- dry mouth

buproprion indication or like when it can be used

- lethargy

- sexual dysfunction

mirtazapine SE

- sedation

- weight gain

- dry mouth

mirtazapine indication

- insomnia

- anorexia, nausea

- weight loss

trazadone

best used for sleeping agent (causes sedation, dizziness, orthostatic hypotension, PRIAPISM, cognitive impairment)

meds associated w/ depression

- beta blockers

- anti HTNs

- corticosteroids

- benzos

- anticonvulsants

- anticholinergics

- opioids

- chemo

uncomplicated UTI Tx (including LTC resident +/- foley, is afebrile)

nitrofurantoin

urosepsis Tx

IV ceftriaxone + vancomycin

aspiration PNA Tx from skilled nursing facility

Ceftriaxone IV + Azithro

hypothyroidism Tx in elderly, concerned for what?

T4, levothyroxine; can enhance the effect of warfarin, increasing bleeding risk

dyspnea in pt, no longer responsive to therapy

low dose opioid:

- morphine PO prn, consider ER

consider benzo if also experiencing anxiety

nausea Tx (toxins, chemo, opioids)

-Dopaminergic Antagonists (Prochlorperazine, Olanzapine)

-5-HT3 Antagonists (Ondansetron)

-Neurokinin-1 Receptor Antagonists (Aprepitant)

nausea Tx (vestibular disturbance)

-Anticholinergics (Scoplomine Patch)

-Antihistamine (Diphenhydramine)

nausea Tx (gastroparesis, partial bowel obstruction)

-Prokinetic Agents (Metoclopramide)

-Complete or Refractory Bowel Obstruction (bowel rest +/- NG suction)

-H2 Blockers (Famotidine - reduces secretions)

-Octreotide (reduce secretions, activity)

-Corticosteroids (decreases swelling, alleviate obstruction)

nausea Tx (anticipation)

benzos (lorazepam, alprazolam)

nausea Tx (increased ICP)

- corticosteroids

- dexamethasone

laxatives

- bowel regimen (senna)

- polyethylene glycol

- lactulose

fatigue

- ginseng (C/I w/ anticoags)

- corticosteroids (short term)

- caffeine

delirium, agitation

- rameltron (melatonin agonist, best if older and hospitalized)

- neuroleptic agents (haloperidol, risperidone, best if only used to sedate for safety purposes)

- benzos (avoid unless there's a reason)

depression + fatigue

consider SSRI/SNRI + psychostimulant (methylphenidate, dextroampheamine)

meds to consider if pt is dizzy

- antiHTN

- diuretics

- sedatives

- ototoxic drugs

BPPV med

meclizine

what do you give w/ iron to enhance it's absorption

vitamin C

meds for short term Tx of insomnia

- lorazepam

- temazepam

- zolpidem

- zaleplon

- antihistamines

- trazadone

- melatonin

restless leg syndrome meds

- dopaminergic agents

- gabapentin

REM sleep behavior disorder meds

- clonazepam

- melatonin

BPH meds

- alpha 1 blockers (tamsulosin, improves urinary flow by relaxing smooth muscle)

- 5-alpha reductase inhibitors (finasteride, reduces prostate volume over time)

- combination if severe

- anticholinergics or beta 3 agonists w/ concurrent overactive bladder