Duke PA Pharmacology Geriatrics
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
|
|
||||
|---|---|---|---|---|---|
| factors that affect the absorption of drugs in the elderly | decreased GI motility, decreased GI blood flow, increased gastric pH
🗑
|
||||
| if GI motility is decreased but GI blood flow is decreased how is absorption affected in the elderly | absorption time is increased therefore drug absorption is quantitatively unaffected
🗑
|
||||
| change in body composistion as we age | decrease in lean body mass, increase in adipose tissue
🗑
|
||||
| fat soluble drugs' volume of distribution __ with age | increases
🗑
|
||||
| water solubel drugs' volume of distribution __ with age | decreases
🗑
|
||||
| with drugs that bind to albumin a decrease in total body water and a decrease in albumin lead to an increase in __ | free drug
🗑
|
||||
| __ blood flow decreases with age affecting the speed at which drugs are metabolised | hepatic
🗑
|
||||
| which phase of drug metabolism decreases little with age | phase II (conjugation reactions)-acetylation, sulfonation, glucoronidation
🗑
|
||||
| MS is a 76 year old male who tried behavioral modifications, but he still has anxiety and difficulties sleeping at night. Which benzodiazepine is the most appropriate? | temazepam
🗑
|
||||
| ZD is a 75 year old female who recently started taking Naproxen 200mg every 8 hours OTC. What might concern you regarding this elderly patient? | decreased GI motility
🗑
|
||||
| decrease in renal blood flow, renal function affects __ of drug and may result in accumulation | elimination
🗑
|
||||
| common drugs with renal impairment recommendations | allopurinol, aminoglycosides, nitrofurantoin, cephalosporins, digoxin, hydrochlorothiazide, vancomycin, amantadine, ranitidine, lithium, NSAIDs, insulin, metformin, sulfamethoxole/trimethoprim
🗑
|
||||
| if renal clearance is less than __ then hydrochlorothiazide is not as effective | 30
🗑
|
||||
| lean body mass decreases with age so as we age __ may not adequately reflect renal function | serum creatinine
🗑
|
||||
| measuring serum creatinine in an elderly patient may lead to what assumption | overestimation of renal function b/c of reduced muscle mass
🗑
|
||||
| elderly have an increased sensitivity to __ | narcotics, benzodiazepines, anticoagulants
🗑
|
||||
| elderly have a decreased sensitivity to __ | beta-adrenergic blockers
🗑
|
||||
| elderly have a decreased __receptor function | baro
🗑
|
||||
| any symptom in an elderly person should be considered a __ until proven otherwise | drug side effect
🗑
|
||||
| highly protein bound drugs | phenytoin, warfarin
🗑
|
||||
| narrow therapeutic index drugs | digoxin, phenytoin, warfarin, carbamazepine, theophylline, levothyroxine, cyclosporine, lithium, procainamide, ethosuximide
🗑
|
||||
| grapefruit interacts with | statins (atorv/lov/simv), calcium channel blockers (diltiazem,felodipine,nicardipine,verapamil), amiodarone, cilostazol, losartan
🗑
|
||||
| drug disease interaction with dementia and | anticholinergics, opiates, psychotropics
🗑
|
||||
| in a patient with BPH __ can cause obstructive urinary symptoms | anticholinergics
🗑
|
||||
| postural hypotension is exacerbated by | diuretics, antihypertensives, antidepressants, levodopa
🗑
|
||||
| ways to improve adherence to medication regimen | pillboxes, simplify regimens, med counseling, associate with part of daily routine, identify barriers
🗑
|
||||
| potential barriers to patient adherence to medication regimen | cost, visual impairment, dexterity, literacy/understanding
🗑
|
||||
| discontinue meds with __ to combat polypharmacy | no benefit/no indication
🗑
|
||||
| do not treat __ with another medication | an ADE
🗑
|
||||
| indicated post MI | aspirin, beta blockers
🗑
|
||||
| aspirin is indicated in which situations | post MI, CAD, TIA, angina, PVD, stroke prevention
🗑
|
||||
| meds indicated for hypertension | beta blockers, ACE inhibitors
🗑
|
||||
| meds indicated in heart failure | ACE inhibitor, spironolactone
🗑
|
||||
| meds indicated in hypercholesterolemia | statins
🗑
|
||||
| meds indicated in atrial fibrillation | warfarin
🗑
|
||||
| what is the Beers criteria used to address | inappropriate medication use in the older adult
🗑
|
||||
| characteristics of osteoporosis | low bone mass, deterioration of bone tissue and disruption of bone architecture, comprimised bone strength, and an increase in the risk of fracture
🗑
|
||||
| peak bone mass by age __ | 25-30
🗑
|
||||
| removal of older bone, replaced with new bone | bone remodeling
🗑
|
||||
| function of osteoclasts | breakdown old bone (clasts-crunch)
🗑
|
||||
| function of osteoblasts | build new bone (blasts-build)
🗑
|
||||
| BMD T score of -1 and above | normal bone
🗑
|
||||
| BMD T score of -1 and 2.5 | osteopenia
🗑
|
||||
| BMD T score of -2.5 and below | osteoporosis
🗑
|
||||
| risk factors for osteoporosis | low calcium, high caffeine, alcohol, smoking, vit D insufficiency, high salt intake, low activity, falling, excess vit A, aluminum, thinness
🗑
|
||||
| medications that are risk factors for osteoporosis | heparin, anticonvulsants, cyclosporine A and tacrolimus, gonadotropin releasing hormone agonists, barbituates, lithium, depo-medroxy-progesterone, chemo, glucocorticoids
🗑
|
||||
| BMD testing for women >__ yo | 65
🗑
|
||||
| BMD testing for men >__ yo | 70
🗑
|
||||
| BMD testing for women or men at __ with risk factors for osteoporosis | 50-69
🗑
|
||||
| universal recommendations to protect bone mass | adequate intake of calcium and vitamin D
🗑
|
||||
| adverse effects of calcium | constipation, bloating, cramps, flatulance, reduced absorption of meds (levothyroxine, iron, tetracycline, fluoroquinolones)
🗑
|
||||
| who doe we treat for for osteoporosis? postmenopausal women and men age 50 and up with__ | hip/vertebral fx, hip/femoral neck or spine T-score < or = -2.5, low bone mass and a US-adapted 10 yr probability of a hip fx >3% or of any major osteoporosis related fx
🗑
|
||||
| approved treatments for osteoporosis | bisphosphonates, calcitonin, estrogens/hormone therapy, estrogen agonist/antagonist, parathyroid hormone
🗑
|
||||
| FDA approved bisphosphonates | alendronate (fosamax), ibandronate (boniva), risedronate (actonel), zoledronic acid (reclast)
🗑
|
||||
| bisphosphonate MOA | decrease bone resorption by binding to the bone matrix and inhibiting osteoclast activity. remains in bone for a long period of time
🗑
|
||||
| bisphosphonate administration (alendronate and risedronate) | take after an overnight fast, with 8 oz plain water, sit or stand for 30 min, do not take with other meds or fluids, do not chew or suck the tablet
🗑
|
||||
| ibandronate administration | take after an overnight fast, with 8 oz plain water, sit or stand for 1 hr, do not take with other meds or fluids, do not chew or suck the tablet, do not eat for 1 hour
🗑
|
||||
| administration of zolendronic acid | intravenous infusion over 15 minutes once yearly
🗑
|
||||
| AE's of bisphosphonates | GI (difficulty swallowing, inflammation of esophagus, gastric ulcer), ab pain, nausea, dyspepsia, osteonecrosis of jaw (rare)
🗑
|
||||
| calcitonin MOA | reduces # of osteoclasts and prevents resorptive activity. temporarily improves bone formation by increasing osteoblastic activity
🗑
|
||||
| calcitonin AE's | dermatologic (flushin, edema at inj site), GI (nausea, diarrhea), musculoskeletal (back/joint pain), respiratory (rhinitis, nasal irritation)
🗑
|
||||
| estrogen reduces the risk of | vertebral fx, hip fx, osteoporotic fx
🗑
|
||||
| estrogen increases the risk of | MI, stroke, invasive breast cancer, PE/DVP
🗑
|
||||
| estrogen agonist/antagonist MOA | selective estrogen receptor modulator, estrogen agonist in bone, decreases bone resorption and bone turnover, increases bone mineral density
🗑
|
||||
| serious estrogen agonist/antagonist AE's | DVT, PE, stroke, MI
🗑
|
||||
| parathyroid hormone MOA when given once daily | preferential stimulation of osteoblastic activity over osteoclastic activity
🗑
|
||||
| parathyroid hormone AE | Cardiovascular (hypotension, syncope), Derm (rash, sweating), Endocrine (hyperuricermia), GI (constipation, diarrhea, indigestion, N/V), Musculoskeletal (arthralgia/spasm), Neurologic (asthenia, dizziness), resp (cough, pharyngitis, rhinitis)
🗑
|
||||
| medications that may induce dementia/delerium | psychotropics, sedatives, hypnotics, cardiac antiarrhythmics, meds with anticholinergic properties
🗑
|
||||
| medications with anticholinergic properties | oxybutynin, diphenhydramine, tolterodine, amitriptyline, doxepin, benztropine
🗑
|
||||
| with alzheimer's disease there are no treatments that __ | reverse the disease, stop the disease
🗑
|
||||
| goals of alzheimer's treatment | preserve cognitive and functional ability, minimize behavioral disturbances, slow the progression of the disease
🗑
|
||||
| pharmacological therapies for alzheimer's disease | cholinesterase inhibitors, NMDA antagonists
🗑
|
||||
| cholinesterase inhibitors used for treatment of alzheimer's | tacrine (Cognex), donepezil (Aricept), rivastigmine (Exelon), galantamine (Razadyne)
🗑
|
||||
| cholinesterase inhibitors MOA results in __ | an increase of acetylcholine available for synaptic transmission in the CNS
🗑
|
||||
| donepezil has a __ half life | long- 70 hours
🗑
|
||||
| rivastigmine has a __ half life | very short - 1 hour
🗑
|
||||
| Donepezil is used for __ Alzheimer's | mild, moderat, and severe
🗑
|
||||
| galantamine has a __ half life | short - 7-8 hours
🗑
|
||||
| memantine has a __ half life | long 60-100 hours
🗑
|
||||
| memantine is used for __ Alzheimer's | moderate to severe
🗑
|
||||
| vitamin E with alzheimer's/dementia | no benefit with mild cognitive impairment
🗑
|
||||
| elderly patients with dementia related psychosis treated with antipsychotic drugs are at an increased risk of __ | death
🗑
|
Review the information in the table. When you are ready to quiz yourself you can hide individual columns or the entire table. Then you can click on the empty cells to reveal the answer. Try to recall what will be displayed before clicking the empty cell.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Created by:
bwyche
Popular Medical sets