Flashcards in Polypharm Deck (12)
Examples of adverse drug events. (**Anytime you have a pt with one of these problems you have to r/o adverse drug event)
Polypharmacy: takeing 4 or more medications.
Adverse drug events:
-MC cause of death from adverse drug reactions = GI bleeding, intracranial bleeding, and renal failure.
How does polypharmacy occur?
What are the MC drugs associated with adverse events?
List the common sx that may be 2ndry to an adverse drug reaction.
new prescriptions, failure to discontinue old prescriptions
MC drugs w/ Adverse events:
Common Sx of adverse drug rxn:
-falls, orthostatic hypotension, heart failure, delirium
Describe how drug metabolism differs in older adults in each of the following:
Liver: hepatic blood flow is decreased by 40% leading to decreased first pass metabolism. (ex. warfarin, BZD, opiates require smaller doses)
Kidneys: renal blood flow can decrease by about half at 80 YO.
Weight: decreased lean body weight to body fat ratio alters the distribution of drugs in the body
Decreased serum protein; drugs that are protein bound are now free to act resulting in a small dose needed fro the desired effect.
Substance abuse: can cause a change in drug metabolism.
What tools are beneficial to consult when deciding what medications to avoid/use in your elderly patients?
Beers criteria is a list of inappropriate medication use in elderly persons.
STOPP is another screening tool that says consider stopping this medication in elderly patients
START: screening tool to alert prescribers to right treatment
What are some examples of medications found on the BEERS criteria that are potentially inappropriate for elder patients. Why are they on this list?
Nitrofurantioin - potential for pulmonary toxicity. lack of efficacy with CrCl less than 30ml/min d/t inadequate drug concentration in urine
Digoxin doses greater than 125mcg; increased risk of toxicity d/t decreased renal clearance and decreased protein binding.
Sliding scale insulin: high risk of hypoglycemia w/o improvement of hyperglycemia management
Sulfonylureas: glyburide = prolonged hypoglycemia
-increased risk of GI bleeding, PUD
*use of PPI or misprostol decreases risk
What are some drugs that may worsen constipation?
antimuscarinics for urinary incontinence... Oxybutynin, tolterodine
nondihydropyridine calcium channel blockers...verapamil, diltiazem
first generation antihistamines
Which medications may cause or exacerbate SIADH?
What are 12 inappropriate drugs in the elderly?
SNRIs, SSRIs, Antipsychotics
-chlorpropamide and glyburide
-digoxin (greater than 0.125mcg)
-GI antispasmodics: belladonna, dicyclomine, hyoscyamine
-dry mouth, confusion, urinary retention, constipation
According to START,what are the MC drug omissions?
-statins in atherosclerotic dz
-warfarin in chronic afib
-anti-platelet therapy in arterial dz
-calcium/vitD supplementation in symptomatic osteoporosis
what is "choosing wisely"?
initiative of the american board of internal medicine, 2 lists of "Five things physicians and patients should question". Addresses screening tests, medications, etc.
Can antipsychotics be used as first choice to treat behavioral and psychological sx of dementia?
Should you avoid using medications to achieve A1C of less than 7.5% in most adults greater than 65?
It is okay to use benzodiazepines or other sedative hypnotics in older adults as first choice for insomnia, agitation, or delerium..T/F?
It is safe to use antimicrobials to treat bacteriuria in older adults w/o sx, T/F?
Do not prescribe cholinesterase inhibitors for dementia without periodic assessment for preceived cognitive benefits and adverse GI effects, T/F?
No, antipyschotics cannot be used as first choice.
Yes, you should avoid using medications to achieve A1C greater than 7.5%
False. do not use benzos.
False, do not use antimicrobials to treat bacteriuria in older adults unless specific urinary tract sx are present.
True, do not prescribe cholinesterase inhibitors for dementia without period assessment.