thera II test II geriatrics

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thera II test II geriatrics
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2013-04-05 07:30:30
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thera II test II geriatrics
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  1. 2 main challenges to geriatric pharmacotherapy
    • they use more OTC = drug-drug interactions
    • high users of alternative medicines
  2. primary therapeutic goal for elderly
    keeping persons independent for as long as possible
  3. 2 challenges to achieving therapeutic goals
    • chronic conditions
    • physiologic changes occur which alter drug pharmacokinetics and pharmacodynamics
  4. 8 most common chronic conditions in non-institutionalized pts
    • arthritits
    • HTN
    • hearing impairments
    • heart disease
    • cataracts
    • orthopedic impairments
    • sinusitis
    • diabetes
  5. 5 most common chronic conditions for institutionalized pts
    • cardiovascular disease
    • cerebrovascular disease
    • mental disorder
    • nervous system of sensory impairment
    • complications secondary to injuries
  6. 6 leading causes of death in the elderly
    • heart disease
    • cancer
    • cerevrovascular disease
    • pneumonia/influenza
    • Dm
    • accidental injuries
  7. 5 body composition changes in elderly
    • decrease
    •    total body water
    •    lean body mass
    •    serum albumin
    • increase
    •    body fat
    •    alpha-1 acid glycoprotein
  8. 4 cardiovascular changes
    • decrease
    •    myocardial sensitivity to beta-adrenergic stimulation
    •    baroreceptor activity
    •    CO
    • increase
    •    peripheral resistance
  9. 2 changes to CNS
    • decrease weight and volume of the brain
    • alterations in several aspects of cognition
  10. 3 endocrine changes
    • thyroid gland atrophies
    • menopause
    • increase in incidence of DM
  11. 4 GI changes
    • increase gastric pH
    • decrease GI blood flow
    • delayed gastric emptying
    • slowed intestinal transit
  12. 3 GU changes
    • atrophy of the vagina due to decreased estrogen
    • prostatic hypertrophy due to androgenic hormonal change
    • age-related changes that may predispose to incontinence
  13. 2 liver changes
    • decrease
    •    liver size
    •    liver blood flow
  14. 2 oral changes
    • altered dentition
    • decrease ability to taste sweetness, sourness and bitterness
  15. 5 pulmonary changes
    • decrease
    •    respiratory muscle strength
    •    chest wall compliance
    •    total alveolar surface
    •    vital capacity
    •    maximal breathing capacity
  16. 5 renal changes
    • decrease
    •    GFR
    •    renal blood flow
    •    filtration fraction
    •    tubular secretory function
    •    renal mass
  17. 3 sensory changes
    • decrease
    •    accommodation of the lens of the eyes
    •    conduction velocity
    • presbycusis ( loss of auditory acuity)
  18. 4 skeletal/skin/hair changes
    • loss of skeletal bone mass
    • skin dryness, wrinkling, and changes in pigmentatin, epithelial thinning, loss of dermal thickness
    • decrease
    •    number of hair follicles
    •    number of melanocytes in the hair bulbs
  19. PK distributional changes with the volume of distribution
    • decreased VOD and increased plasma concentration of water-soluble drugs
    • increased VOD and increased terminal disposition half-life of fat-soluble drugs
  20. 4 drugs that could have an increase in free fraction from decreased albumin
    • naproxen
    • phenytoin
    • tolbutamide
    • warfarin
  21. 4 drugs that could have a decrease in free fraction due to increase AAG
    • lidocaine
    • propranolol
    • quinidine
    • imipramine
  22. 7 drug affected by decreased renal clearance
    • amantadine
    • aminoglycosides
    • atenolol
    • cimetidine
    • digoxin
    • lithium
    • vancomycin
  23. 14 "I's" of geriatrics
    • iatrogenesis
    • isolation
    • immobility
    • impaction
    • impaired senses
    • impotence
    • immunodeficiency
    • immunization
    • incontinence
    • infection
    • inanition(malnutrition)
    • instability
    • intellectual impairment
    • insomnia
  24. Weakness
    Confusion
    Syncope
    Abdominal pain
    acute MI
  25. Instead of dyspnea, the older patient may present with hypoxic symptoms
       Lethargy
       Restlessness
       Confusion
    chronic hear failure
  26. Although the mortality rate is about 10%, presenting symptoms are nonspecific, ranging from mental status changes to syncope with hemodynamic collapse
    GI bleed 
  27. Lethargy
    Confusion
    Anorexia
    Decompensation of a preexisting medical condition
    URI
  28. Incontinence
    Confusion
    Abdominal pain
    Nausea/vomiting
    Azotemia
    UTI
  29. behavior indicators of depression
    • Social isolation
    • Self-neglect
    • Anxiety/Nervousness
    • Sadness
    • Lack of reaction to pleasant events
    • Irritability/Agitation
    • Multiple physical complaints
    • Loss of interest
    • Appetite loss
    • Lack of energy
  30. behavioral indicators of pain
    • Grimacing or wincing
    • Bracing or guarding
    • Rubbing
    • Changes in activity level
    • Sleeplessness, restlessness
    • Resists movement
    • Withdrawal / apathy
    • Increased agitation or anger
    • Decreased appetite
    • Vocalizations
  31. medications that can increase the risk of fall
    • Sedatives
    • benzodiazepines
    • phenothiazine
    • antidepressants
    • antihypertensives
    • antiarrhythmics
    • anticonvulsants
    • diuretics
    • alcohol
    • anticholinergics
  32. 6 most common infections in the elderly
    • Urinary tract infections
    • Pneumonia
    • Pressure sores/skin infections
    • Tuberculosis (lower for non-institutionalized elderly)
    • Bacteremia
    • Infective endocarditis
  33. most common complaint in elderly
    constipation
  34. Pt. does not follow a prescribed treatment regimen
    Implies disobedience to an authority
    noncompliance
  35. Pts. do not take their medications as they are prescribed.
    Intentional & Unintentional
       Failure to fill Rx, failure to pick up from pharmacy, failure to refill
    nonadherence
  36. 6 behavioral/cognitive contributors to nonadherance
    • Cognitive decline
    • Social isolation
    • Lack of support system
    • Perceptions on health
    • Financial worries
    • Health Literacy Problems
  37. 3 physiological contributors to nonadherence
    • poor dexterity
    • hearing loss
    • vision loss
  38. 3 provider/patient contributors to nonadherence
    • Patient knowledge of disease/illness
    • Patient knowledge of medication
    • Patient satisfaction with provider
  39. 6 keys to comprehensive geriatric assessment
    • History
    • Assessing and monitoring drug therapy
    • Documenting problems and formulating a therapeutic plan
    • Consulting with the other healthcare providers
    • Patient/Caregiver counseling
    • Aids to improve adherence
  40. 11 drugs to avoid according to Beer's
    • nitrofurantoin
    • antipsychotics
    • insulin - sliding scale
    • chlorpropamide, glyburide
    • BZ's
    • megestrol
    • metoclopramide
    • non-COX NSAIDS
    • non-BZ hypnotics
    • estrogens
    • muscle relaxants

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