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17 Cards in this Set
- Front
- Back
How many community seniors experience a drug side effect?
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10 to 25 %
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How many nursing home seniors experience a side effect?
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over 50%
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What percentage of hospital admissions of seniors are because of drug events?
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30%
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Seniors have increased adverse drug events. Why?
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number of drugs
multiple co-morbidities less reserve (frail) altered pharmacokinetics |
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What is the most common adverse drug event error?
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dose errors --> starting at too HIGH a dose
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What are some pharacokinetic changes with aging?
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inc gastric pH - Ca problems
inc body fat - diazepam dec body water - digoxin dec albumin - phenytoin |
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What is the most clinically important thing in pharmacokinetics of aging?
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decreased renal function
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What are the chances of drug drug interactions?
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2 drugs - 6%
5 drugs - 50% 8 drugs - 100% |
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What are some examples of drug-drug interactions?
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impair absorption (Ca and Bis)
cytochrome P450 opposite effect (Cholinesterase ihib and antichol) impair excretion (thiazide and lithium) |
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Why are adverse drug events missed?
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-underlying disease (HTN, CHF, edema)
-atypical presentation -attributed to aging |
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What are some ADE reasons for clinical presentations in eldergly?
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confusion - benzos, anticholinergics, amitryptiline
falls - ortho HTN, sedation dec appetite - iron, metformin constipation - verpamil, iron |
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What is the prescribing cascade?
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side effect misdiagnosed as a new disease
new drug prescribed for side effect e.g. NSAID --> HTN --> CHF |
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What is another hidden reason for an ADE?
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noncompliance or nonadherence
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What kinds of diseases are under-treated?
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MI
CHF AF osteoporosis |
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In older people, they have higher ________ blood pressure in HTN
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systolic
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What factors contribute to medication appropriateness?
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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 |
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What to do to reduce polypharmacy?
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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 |