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17 Cards in this Set

  • Front
  • Back
How many community seniors experience a drug side effect?
10 to 25 %
How many nursing home seniors experience a side effect?
over 50%
What percentage of hospital admissions of seniors are because of drug events?
30%
Seniors have increased adverse drug events. Why?
number of drugs
multiple co-morbidities
less reserve (frail)
altered pharmacokinetics
What is the most common adverse drug event error?
dose errors --> starting at too HIGH a dose
What are some pharacokinetic changes with aging?
inc gastric pH - Ca problems
inc body fat - diazepam
dec body water - digoxin
dec albumin - phenytoin
What is the most clinically important thing in pharmacokinetics of aging?
decreased renal function
What are the chances of drug drug interactions?
2 drugs - 6%
5 drugs - 50%
8 drugs - 100%
What are some examples of drug-drug interactions?
impair absorption (Ca and Bis)
cytochrome P450
opposite effect (Cholinesterase ihib and antichol)
impair excretion (thiazide and lithium)
Why are adverse drug events missed?
-underlying disease (HTN, CHF, edema)
-atypical presentation
-attributed to aging
What are some ADE reasons for clinical presentations in eldergly?
confusion - benzos, anticholinergics, amitryptiline
falls - ortho HTN, sedation
dec appetite - iron, metformin
constipation - verpamil, iron
What is the prescribing cascade?
side effect misdiagnosed as a new disease
new drug prescribed for side effect
e.g. NSAID --> HTN --> CHF
What is another hidden reason for an ADE?
noncompliance or nonadherence
What kinds of diseases are under-treated?
MI
CHF
AF
osteoporosis
In older people, they have higher ________ blood pressure in HTN
systolic
What factors contribute to medication appropriateness?
not solely based on age
do not underestimate life expectancy
not all drugs are bad: can improve QOL
needs change over time (e.g. weight)
functional state imp in prognosis
What to do to reduce polypharmacy?
appropriate meds
review meds and know what they do
for every sx think "meds, meds, meds"
evidence helps prioritize
start low, go slow
learn side effects and actively monitor
review, communicate at discharge