Abraham 4-10-08 Drugs For The Geriatric Patient

Front 1

Geriatric pts fill __ Rx/year compared to only _/year on average for patients<45

Back 1

Geriatric pts fill 12 Rx/year compared to only 5/year on average for patients<45

Front 2

Geriatric pts today represents approx. __% of the total population but purchase __% of all prescription drugs, and 40% of all OTC medications sold in the US

Back 2

Geriatric pts today represents approx. 13% of the total population but purchase 33% of all prescription drugs, and 40% of all OTC medications sold in the US

Front 3

by 2040, estimated geri pts will represent __% of total population and will buy __% of all prescription drugs

Back 3

by 2040, estimated geri pts will represent 25% of total population and will buy 50% of all prescription drugs

Front 4

Why Geriatric Pharmacotherapy is Challenging

Back 4

More drugs
No FDA trials specific for old pt
insurance plans
drug-drug interactions = large knowledge base
Herbal supplements
OTC

Front 5

What is the name of the science of mathematics associated with the process of:
Absorption
Distribution
Metabolism
Elimination

Back 5

Pharmokinetics

Front 6

Is drug absorption (bioavailability) affected by age?

Back 6

not really

Front 7

Factors that Affect Absorption

Back 7

Route of administration
Co-morbid illnesses
Enteral feedings
Drugs that affect GI motility
chronic constipation

Front 8

With increasing age, the lean-to-fat ratio of the body mass __creases, as does total body water

Back 8

With increasing age, the lean-to-fat ratio of the body mass decreases, as does total body water

Front 9

Is Metabolism affected by age?

Back 9

Yes: Normal aging decreases liver blood flow, size, mass, and enzymatic activity

Front 10

Is Elimination affected by age?

Back 10

Yes:
Aging and common geriatric disorders can impair kidney function by:
decreasing kidney size
decreasing renal blood flow
decreasing number of functioning nephrons
decreasing renal tubular secretion
Result: lower glomerular filtration rate

Front 11

Keys to renal function in elderly

Back 11

BUN and Creatinine may not accurately reflect true renal function of the elderly
Serum creatinine does not reflect creatinine clearance
Result: in older persons, serum creatinine stays in normal range, masking change in creatinine clearance

Front 12

Two Ways to Calculate Creatinine Clearance

Back 12

24 urine collection
Cockroft - Gault
wt(kg)(140-age)/ [serum creatinine (mg/dl)*72] all * 0.85 if female

Front 13

The elimination half life is determined by the Vd (volume of distribution) of the drug and its____________

Back 13

The elimination half life is determined by the Vd (volume of distribution) of the drug and its clearance

Front 14

Benzodiazepines may cause more _________ and poorer psychomotor performance in older adults

Back 14

Benzodiazepines may cause more sedation and poorer psychomotor performance in older adults

Front 15

Older patients may experience higher levels of morphine with longer pain relief due to altered metabolism but danger in increased for respiratory __________

Back 15

Older patients may experience higher levels of morphine with longer pain relief due to altered metabolism but danger in increased for respiratory depression

Front 16

Prolonged half life and decreased __________ are associated with increased risk of adverse drug reaction in the elderly

Back 16

Prolonged half life and decreased elimination are associated with increased risk of adverse drug reaction in the elderly

Front 17

Abide by the Rule: GO LOW AND GO____!

Back 17

Abide by the Rule: GO LOW AND GO SLOW!

Front 18

Adverse Drug Events Mimic many geriatric syndromes, the most commonly thought of is _________

Back 18

Adverse Drug Events Mimic many geriatric syndromes, the most commonly thought of is dementia

Front 19

Adverse effects are frequently ____ related so adjust the dose

Back 19

Adverse effects are frequently dose related so adjust the dose

Front 20

Any new symptom or condition in an elderly patient should be considered a _______________ until proven differently!

Back 20

Any new symptom or condition in an elderly patient should be considered a drug side effect until proven differently!

Front 21

Piroxicam ADE (NSAID)

Back 21

edema, and hypertension, GI bleed, misinterpreted as a new medical condition

Front 22

Chlorthalidone ADE (thiazide)

Back 22

low K, weakness, dizziness, cramps, misinterpreted as a new medical condition

Front 23

ADE’S are responsible for 5 to __% of acute geriatric hospital admissions

Back 23

ADE’S are responsible for 5 to 28% of acute geriatric hospital admissions

Front 24

Elderly are _ times more likely to die from a medical error than an accident outside of the hospital

Back 24

Elderly are 8 times more likely to die from a medical error than an accident outside of the hospital

Front 25

In nursing homes, $1.__ is spent on ADE’s for every $1.00 spent on medications

Back 25

In nursing homes, $1.33 is spent on ADE’s for every $1.00 spent on medications

Front 26

Avg. NH patient takes more than _ drugs daily and 20% take more than 10

Back 26

Avg. NH patient takes more than 6 drugs daily and 20% take more than 10

Front 27

most common reported ADE’s in NH

Back 27

Neuropsychiatry events such as confusion, sedation, delirium, falls, and hemorrhage

Front 28

Most Common Medications Involved in ADE’s

Back 28

1. Cardiovascular Agents
2. CNS Agents
3. Musculoskeletal agents
4. Anticoagulants

Front 29

Potentially Inappropriate Medications for the Elderly
High Potential for SEVERE ADEs:

Back 29

Amitriptyline
Chlorpropamide (sulphonylurea)
Digoxin >0.125 mg/day
Disopyramide
GI antispasmodics
Meperidine
Methyldopa
Pentazocine (Talwin) narc
Ticlopidine
Long acting benzodiazepines

Front 30

High Potential for LESS SEVERE ADEs:

Back 30

Antihistamines
Diphenhydramine
Dipyridamole (anti-thrombus)
Ergot mesylates
Indomethacin
Meperidine, oral
Muscle relaxants

Front 31

Risk Factors for ADE’s

Back 31

6 or more concurrent chronic conditions
12 or more doses of drugs/day
9+ medications
Prior adverse drug reaction
Low body weight
Age 85+
Est. Crcl < 50 mL/min

Front 32

MC drug types involved in drug-drug interactions

Back 32

cardiovascular and psychotropic drugs

Front 33

Common Adverse Effects of Drug-Drug Interactions

Back 33

Confusion
Cognitive impairment
Arterial hypotension
Acute renal failure
Edema/worsening CHF
Altered GI function
Gait and movement abnormalities

Front 34

ACEI + diuretic may cause what bad effects

Back 34

hypotension, hyperkalemia

Front 35

ACEI + potassium

Back 35

hyperkalemia

Front 36

Antiarryhmic + diuretic

Back 36

electrolyte imbalance, arrythmias

Front 37

BZD + antidep, antipsych, or BZD

Back 37

Confusion, sedation, falls

Front 38

CCB + diuretic or nitrate

Back 38

Hypotension

Front 39

digitalis + antiarrhythmic

Back 39

bradycardia and arrhythmia

Front 40

basic principles of prescirbing for older pts

Back 40

Start with a low dose
Titrate upward slowly, as tolerated by the patient
Avoid starting 2 drugs at the same time
Be aware of timing of medication to minimize side effects

Front 41

How often should you review pts drug list?

Back 41

q 6 months