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8 Cards in this Set

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T or F: most studies on efficacy and safety of medications exclude the very old (older than age 75) and those with multiple medical problems. As a result the benefits, risks and dosages of drugs seen in younger, healthier populations may not apply to older patients.
What are older adults at a higher risk for adverse effects?
1. They take more medications (30% take at least 4 drugs)
2. They have more underlying disease
3. Older adults have altered pharmacokinetics (e.g. reduced renal clearance not accurately reflected by serum creatinine) and pharmacodynamics (e.g. more sensitive to warfarin and psychoactive drugs)
4. Polypharmacy decreases compliance
When should you suspect an adverse effect from drugs/polypharmacy?
Always suspect drugs as a cause of new symptoms. Adverse consequences are often nonspecific, such as dizziness, falls, confusion, or altered bowel and bladder function.
Why should you particularly scrutinize hospitalized patients for adverse effects from drugs or polypharmacy?
Up to 25% of admissions of older adults are for drug-related problems, most often resulting from adverse effects rather than patient error or noncompliance.
What medications are more commonly associated with adverse effects in the elderly?
1. antihypertensives
3. H2-blockers
4. tricyclic antidepressants
5. narcotics
6. sedatives
*review over-the-counter agents as well
How can I best avoid polypharmacy and adverse drug events in the elderly?
1. Limit patients to 4 drugs if at all possible
2. Start at the lowest recommended dose
3. Assess for drug interactions
4. Make dosage changes necessitated by altered metabolism
5. calculate creatine clearance rather than relying on serum creatinine to assess renal function.
6. Use Medisets, simple regimens and patient education
How can I safely withdraw medications in older adults?
Withdraw (or start taper) drugs whenever problematic polypharmacy is suspected. In one study, 1 out of 4 drugs were stopped and 74% of drug discontinuations occurred without incident. No deaths were associated with the infrequent disease exacerbations that did occur when medications were stopped.
Which drugs require slow tapering to avoid physiologic withdrawal?
1. steroids
2. beta-blockers
3. benzos
4. antidepressants