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  1. What are some contributing factors for drug complications in the elderly?
    • Altered pharmacokinetics – Adverse drug reactions
    • Multiple illness: More illness=more complication.
    • Multiple drug therapy—Polypharmacy
    • Poor compliance: Causes problems if not completed.
    • Medication Errors
    • Inappropriate prescribing
    • Excessive drug costs
    • Adverse drug rxn=any unintended effect of the drug.
    • Polypharm: meds and vitamins are usually taken handfuls at a time.
    • Medication errors: one of the top reasons people are admitted
    • Inappropriate prescribing: Many Dr. don’t yet utilize electronic medical records, so drug mixups and contraindications can occur due to lack of information.
    • Excessive drug costs (Plavix just went generic. Decreases “stickiness” of RBCs--> reduced blood clots. Will drop cost of drug.)
  2. Altered pharmacodynamics in the elderly...
    • Distribution:
    • Decreased percentage of sub q fat
    • Increased percentage of body fat.
    • Decreased percentage of body mass: Lost muscle tissue.
    • Decreased total body water: Increases chance of toxicity.
    • Reduced concentration of serum albumin: decreased absorption of Rx.
    • Metabolism
    • Decreased hepatic metabolism: Decreased metabolism of Rx--> more active drug in system.
    • Excretion
    • Reduced renal excretion--> stays in system for longer
    • Moral of the story: Decrease Dose, Decrease frequency.
  3. How is checking for renal function different in the geriatric population?
    In the elderly, the proper index of renal function is creatinine clearance not serum creatinine.

    • Timed test (12-24hr collection). How much creatinine is collected during that time?
    • Dependent upon having ALL the urine samples.
    • Serum levels and clearance levels should be roughly equal. Must then also have creatinine serum level.
    • If not clearing, think toxicity.
  4. Issues with Adverse Drug Reactions in the Elderly?
    • Seven times more likely in elderly
    • 16% of hospital admissions over 65 yrs.: Due to adverse drug rxn
    • 50% of all medication-related deaths : Due to adverse drug rxn
    • Elderly more likely to have:
    • Confusion: More likely not to take, take wrong way, etc.
    • Poor vision: Takes the wrong one(s) by mistake.
    • Poor memory: Forgets to take. Need to take some kind of adaptive device to help remember when to take.
    • Inappropriate dosing: Less Rx, longer interval.
    • Drug-drug interactions: If taking lots of Rx, almost ensures interactions
    • Polypharmacy: Multiple drugs taken together.
    • Noncompliance: For all the reasons above, and also because sometimes they just don't want to.

    St. John’s Wart: Increases bleeding time, interacts with lots of stuff. Something good to ask about specifically.
  5. How do you monitor for adverse drug reactions?
    • Take thorough drug history
    • Lowest dosing
    • Plasma level monitoring: Getting to therapeutic dose?
    • Simplest regimen
    • Review drug treatment schedule
  6. How do you promote compliance with your elderly patients?
    • Keep the drug regimen simple.
    • Verbal and written instructions: Need to actually review what the medication is, how to take it, how to take it with the other medications they’re taking, etc... And write it down for them.
    • Appropriate dosage form
    • Clear labeling:Why, when, side effects, etc.
    • Daily reminders: Need to be able to track what they have/have not taken. Work into their ADLs.
    • Support system: Needs to be physically present with the pt.
    • Frequent monitoring: Make sure they go for “well checkups.”
Card Set
Chapter 11
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