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22 Cards in this Set
- Front
- Back
describe some barriers to obtaining medication histories in the geriatric population
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communication, lack of medical records, underreporting, multiple medications and diseases
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what does a comprehensive drug list include?
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prescription
OTC dietary supplements |
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describe the prescribing prinicples that should be following for geriatric patients
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start low, go slow
regular drug regimen reviews limit use of prn meds clear, simple and complete directions |
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describe mental status assessment of the geriatric population
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cognitive function: clock drawing test, MMSE
depression rating scales: geriatric depression scale, beck depression inventory EtOH dependence and substance misuse: CAGE screening |
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how is functional status assessed and what are examples of each?
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activities of daily living (ADLs): eating, dressing, bathing, toileting, grooming, physical ambulation
instrumental activities of daily living (IADLs): housework, travel, shopping, laundry, telephone, medication, money, food preparation |
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how is social assessment evaluated in geriatrics?
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content of average day
living arrangements occupational hx social support system |
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what economic circumstances should be taken into consideration with geriatric patients?
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financial constraints
labor force or unemployed sources of income |
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what environmental situations should be considered w/ geriatric pts?
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home safty checklist
physical barriers access to services |
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what are some drug related problems in geriatrics?
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inappropriate prescribing, drug-drug inx, drug-dx(patient)inx, polypharmacy, ADRs, medication non-adherence
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describe inappropriate prescribing as it relates to geriatrics
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prescribing of medications outside bounds of medical standards
prescribing of medications which should be avoided b/c risks outweigh benefits beers criteria = guide for potentially inappropriate medciation use in older adults |
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what are some drugs included on the Beer's list?
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TCAs(amitriptyline), antihistamines (diphenhydramine), muscle relaxants (cyclobenazaprine), BZDs, chlorpropamide
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describe ADRs as they relate to geriatrics
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an unintended, untoward, harmful, or noxious response to a drug occurring at dosage levels for disease prevention, diagnosis, or treatment
35% of ambulatory older adults experience ADRs annually 1/3 of drug related hospitalizations occur in persons >60 |
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describe drug drug inx as they relate to geriatrics
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altered pharmacokinetics or pharmacodynamics of a drug when taken concomitantly with another drug
levo and cholestyramine erythro and theophylline |
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describe drug dx(pt) inx as they relate to geriatrics
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exacerbation of a dx or medical condition by a drug
anticholinergics and BPH coricosteroids and DM |
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describe polypharmacy
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concomitant use of multiple drugs or adminsitration of more medications than are clinically intended
ask about OTCs and dietary supplements risk factors: use of multiple pharmacies and physicians |
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describe medication non-adherence
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extent to which a pt's or caregiver's medication administration coincides w/ medical advice
rate of nonadher may be >50% in persons >60 influenced by various factors: medical, medication, behavioral, economic |
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what are some strategies to avoid drug related problems?
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prescribe only drugs that are indicated
d/c unnecessary drugs consider non-pharm strategies when appropriate monitor drug therapy for benefit and tox educate pt on potential ADRs encourage pt to contact you w/ ?s and concerns provide written and verbal pt education on monitoring parameters discourage sharing of meds w/ fam and friends advise pt and fam to keep written list of meds keep all physicians and pharmacies informed of medication list |
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what are the leading causes of death in people >65?
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heart dx, cancer, cerebrovascular dx, chronic LRI, flu/pneumo, alzheim, DM, kidney dx, injury, sepsis
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what is the effect of age on absorption?
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decreased active transport
decreased first pass increase gastric pH |
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what is the effect of age on distribution?
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decrease total body water
increase fat stores decrease serum albumin |
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what is the effect of age on metabolism?
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decreased hepatic blood flow
decreased hepatic mass |
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what is the effect of age on elimination?
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decrease renal blood flow
decrease renal mass decrease glomerular filtration rate |