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22 Cards in this Set

  • Front
  • Back
describe some barriers to obtaining medication histories in the geriatric population
communication, lack of medical records, underreporting, multiple medications and diseases
what does a comprehensive drug list include?
dietary supplements
describe the prescribing prinicples that should be following for geriatric patients
start low, go slow
regular drug regimen reviews
limit use of prn meds
clear, simple and complete directions
describe mental status assessment of the geriatric population
cognitive function: clock drawing test, MMSE
depression rating scales: geriatric depression scale, beck depression inventory
EtOH dependence and substance misuse: CAGE screening
how is functional status assessed and what are examples of each?
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
how is social assessment evaluated in geriatrics?
content of average day
living arrangements
occupational hx
social support system
what economic circumstances should be taken into consideration with geriatric patients?
financial constraints
labor force or unemployed
sources of income
what environmental situations should be considered w/ geriatric pts?
home safty checklist
physical barriers
access to services
what are some drug related problems in geriatrics?
inappropriate prescribing, drug-drug inx, drug-dx(patient)inx, polypharmacy, ADRs, medication non-adherence
describe inappropriate prescribing as it relates to geriatrics
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
what are some drugs included on the Beer's list?
TCAs(amitriptyline), antihistamines (diphenhydramine), muscle relaxants (cyclobenazaprine), BZDs, chlorpropamide
describe ADRs as they relate to geriatrics
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
describe drug drug inx as they relate to geriatrics
altered pharmacokinetics or pharmacodynamics of a drug when taken concomitantly with another drug
levo and cholestyramine
erythro and theophylline
describe drug dx(pt) inx as they relate to geriatrics
exacerbation of a dx or medical condition by a drug
anticholinergics and BPH
coricosteroids and DM
describe polypharmacy
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
describe medication non-adherence
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
what are some strategies to avoid drug related problems?
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
what are the leading causes of death in people >65?
heart dx, cancer, cerebrovascular dx, chronic LRI, flu/pneumo, alzheim, DM, kidney dx, injury, sepsis
what is the effect of age on absorption?
decreased active transport
decreased first pass
increase gastric pH
what is the effect of age on distribution?
decrease total body water
increase fat stores
decrease serum albumin
what is the effect of age on metabolism?
decreased hepatic blood flow
decreased hepatic mass
what is the effect of age on elimination?
decrease renal blood flow
decrease renal mass
decrease glomerular filtration rate