Geri

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Author:
wackojacko
ID:
186547
Filename:
Geri
Updated:
2012-12-02 11:27:00
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Geri
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Geri
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  1. liver metabolism  phase I
    cytochrome P450; oxidative pathway
  2. phase II
    conjugation pathway
  3. water soluble drugs
    have lower volume of distribution (lower volume of distribution=higher amt of drug)
  4. fat soluble drugs
    have increased volume of distribution (lower blood levels of drug)
  5. protein bound drugs in elderly
    • higher amt of free active drug
    • digoxin, dilantin
  6. elimination:
    half-life in elderly...
    clearance...
    • half life =increased
    • clearance= reduced
  7. elimination:
    effects of aging worse on renal or hepatic
    renal function worse
  8. elimination:
    which is best measurement of clearance?
    • creatinine clearance
    • use cockroft gault equation
  9. risk factors for ADR
    • >6 DX's
    • >12 doses of meds per day
    • >9 meds
    • prior ADR
    • low BW/low BMI
    • CrCl <50ml/min
  10. EBP:
    HTN
    treat SBP >160 w/thiazide diuretic unless compelling indication
  11. EBP:
    DM
    TZD's non-glycemic effects on BW, lipids, and BP
  12. EBP:
    psychotropics
    haldol and risperdal have equal effect; no less likely to cz side effects
  13. EBP:
    antiplatelet
    ASA not better than plavix in CAPRIE study
  14. EBP:
    Aricept
    cholinesterase inhibitors in Alzheimer's dz appeared to be marginal at best
  15. EBP:
    NSAIDS
    CHF, HTN crisis, renal toxicity/ARF hospitalized more for thess than GI effects
  16. EBP:
    COX-2
    • renal effects, edema, HTN appear similar to traditional NSAIDS
    • increased cardiac deaths r/t COX-2's
  17. EBP:
    incontinence
    cholinesterase inhibitors and anticholinergics should not be used in combination
  18. principles for prescribing
    • generics
    • half tabs
    • components
    • reduced dosing frequency
    • alternate day dosing
    • drug holiday
    • extended release drugs (usually not necessary and often dangerous)
  19. eval of falls
    • HX incident
    • review meds
    • review acute and chronic problems
  20. fall exam
    • R/O head and neck injury
    • vision
    • mobility, gait, balance, TXR
    • inspect lower extremities= joints, feet
    • neuro exam= mental status, muscle strength, sensation, reflexes, cerebellar fxn, rhomberg
    • CV exam, orthostatics, pulse
  21. FUO:
    community
    • respiratory
    • UTI
    • abd sepsis
    • TB
    • endocarditis
    • septic arthritis (gout more likely cz of single hot joint than this)
  22. FUO:
    inpatient
    • UTI
    • asp PNE
    • IV line sepsis
    • infected pressure ulcer
    • PE
    • meds

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