Exam 2 - Study Material Flashcards

Question

Why is polypharmacy?

Answer 1

* ¨Use of multiple medications for the same problem * ¨Very common in older adults * ¨Can occur intentionally or unintentionally * ¨Commonly occurs with multiple specialists and lack of communication * ¨Two major concerns: * ¡Increased risk for drug interactions * ¡Increased risk for AE’s

Answer 2

¨Appropriate ú All drugs in the regimen address recognized indications ¨ Inappropriate úMore drugs prescribed than necessary, drugs with unacceptable adverse effects or toxicity prescribed (alone or combined with other drugs), or redundant drugs prescribed

Answer 3

* ¨Noxious response to a drug * ¨Common cause of hospitalization * ¨Some can be predicted * ¨Some can’t be predicted * ¨“Start low, go slow, but go” * ¨Beer’s list * ¨ADE * ¡Report to US Food and Drug Administration

Answer 4

A given dose of a given medication produces a different, and sometimes unexpected, response in an elderly patient compared to a younger patient of the same gender and similar body weight.

Answer 5

* ¨Give lowest dose possible * ¨Discontinue unnecessary therapy * ¨Attempt nondrug approaches first * ¨Give the safest drug possible * ¨Assess renal function * ¨Always consider the risk-to-benefit ratio when adding drugs * ¨Assess for new interactions with any new prescription * ¨Avoid the prescribing cascade * ¨Avoid inappropriate medications

Answer 6

* More than 6 chronic concurrent illnesses * More than 12 doses of medications/day * More than 9 medications * History of prior drug reaction * Low body mass index * Age over 85 * Creatinine clearance less than 50

Answer 7

* Confusion * Depression * Delirium * Insomnia * Parkinson’s-like symptoms * Incontinence * Weakness or lethargy * Loss of appetite * Falls * Changes in speech

Answer 8

* Situation-Current * Background-List medications and provide VS’s * Assessment-I think he/she has….. * Recommendation-I think he/she needs…..

Answer 9

an unpleasant sensory and emotional experience associated with actual or potential tissue damage…always subjective…a sensation…always unpleasant

Answer 10

**Young Adults:** * Clear cause * Due to acute event * Treatment based on severity of pain **Older Adults:** * Pain stems from co-morbid conditions * Persistent * Multi-dimensional

Answer 11

* Nociceptive – skin, tissue * Neuropathic – nerve pain * Mixed or unspecified * Most common type of pain in late life is chronic

Answer 12

* ¨Depression * ¨Eating disturbances * ¨Sleeping disturbances * ¨Functional impairments * ¨Confusion

Answer 13

* Falls * Caregiver strain * Cognitive impairments * Increased dependency * Decline in social and recreational activities * Slowed rehabilitation

Answer 14

¨Healthcare Professional Barriers * Lack of education * Concern regarding regulatory scrutiny * Fears of opioid s/e’s and/or addiction * Belief that it’s a normal part of aging * Belief that cognitively impaired have less pain * Own experiences with pain * Inability to accept self-report without ‘objective’ signs Patient/Family * Fear of s/e’s * Fear of addiction * Belief pain is normal part of aging * Belief nothing can be done * Fear of being a ‘bad’ patient by complaining

Answer 15

* Changes in behavior * Activities of daily living * Vocalizations * Physical changes

Answer 16

**P**ain is real **A**sk about pain regularly **I**solation **N**otice nonverbal pain signs **E**valuate pain characteristics **D**oes pain impair function? **O**nset **L**ocation **D**uration **C**haracteristics **A**ggravating factors **R**elieving factors **T**reatment previously tried

Answer 17

1. ALWAYS START WITH Tylenol, up to 4gs a day, 2. If that doesn’t work start an NSAID, or ibeprophen, cellbrux 3. If pain is moderate and persistent add Vicodin + Tylenol 4. IF pain is moderate to severe add another opioid

Answer 18

* # 1 Nicotine (~18-22%) * # 2 Alcohol (~2-18%) * # 3 Psychoactive Prescription Drugs (~2-4%) * # 4 Other Illegal Drugs (marijuana, cocaine, narcotics) (\<1%)

Answer 19

* Baby boomers (born 1946 to 1964) * Have much higher rates of illicit drug use –history of youth drug use * Generation is larger than earlier cohorts * First generation indoctrinated with “quick-fix” culture (prescription drugs) * Subject to same age related physiological, psychological and social changes as other cohorts

Answer 20

Age-related changes make older adults more vulnerable to adverse alcohol effects * •Higher BAC from a given dose * •More impairment at a given BAC Implications for older adult drinkers: * •Moderate levels of consumption can be more risky * •More consequences from maintaining consumption * •Increased consumption may quickly result in consequences

Answer 21

NIAAA and CSAT recommend that adults age 65 and older follow these drinking guidelines: * •No more than 1 drink per day * •Never more than 2 drinks on any drinking day (binge drinking) Consistent with patterns shown to have potential health benefits Limits for older women should be somewhat lower than those for older men

Answer 22

no alcohol in previous year

Answer 23

alcohol use within guidelines and not associated with problems

Answer 24

:alcohol use that has resulted in adverse medical, psychological or social consequences; or substantially increases the likelihood of such problems

Answer 25

medical disorder characterized by loss of control, preoccupation with alcohol, continued use despite problems, physiological symptoms such as tolerance and withdrawal

Answer 26

* Loss (people, vocation, status) * Social Isolation and loneliness * Major financial problems * Changes in housing * Family concerns * Burden of time management * Complex medical problems * Multiple medications * Sensory deficits * Reduced mobility * Cognitive impairment or loss * Impaired self-care

Answer 27

* Rates of alcoholism appear to decline with age * Drinking patterns that do not meet traditional abuse definitions can lead to higher BAC, chronic illness, poor nutrition and poly-pharmacy in older patients * Extent of problem difficult to determine due to differences in definitions and lack of age-specific measures * If past reliance on alcohol to resolve problems exists, then loss of spouse, occupational and role status, and poor social supports can make older adults more vulnerable to misuse * Less use of illicit drugs * More **_un_**intentional misuse of drugs due to memory loss or misunderstanding of dosing instructions

Answer 28

* Older women may be at greater risk for alcohol problems due to potential loneliness and depression from outliving spouse, other losses * Physiologically at greater risk as they age * Alcohol use recommendations lower than those set for older men and younger women * Screening and brief intervention useful

Answer 29

* Every person age 60 and older should be screened for alcohol and prescription drug use/abuse as part of regular physical examination- ‘Brown Bag Approach’ * Screen or re-screen if certain physical symptoms are present or if the older person is undergoing major life changes or transitions * Ask direct questions about concerns * Preface questions with link to medical conditions or health concerns * **Do not use stigmatizing terms (e.g. alcoholic)**

Answer 30

Application of a test to members of a population for the purpose of estimating their probability of having a specific disorder Examples: Cancer, depression, hypertension

Answer 31

Measure of instrument’s accuracy in detecting individuals who do have an alcohol problem (True positive/ False negative)

Answer 32

Measuring of instrument’s accuracy in identifying individuals who do not have an alcohol problem (True negative/ False positive)

Answer 33

Abstinence or Prevention low-risk drinker message At-risk drinker or Brief drug user with other- intervention wise negative screen Positive screen for abuse Brief or dependence assessment

Answer 34

* Definition: Time-limited (5 minutes to 5 brief sessions) and targets a specific health behavior * Goals: * a) reduce alcohol consumption * b) facilitate treatment entry * Relies on use of screening techniques * Empirical support of effectiveness for younger and older drinkers

Answer 35

* Screening * Feedback * Motivation to change * Strategies for change * Negotiated behavioral contract * Follow-up

Answer 36

1. Precontemplation - Not ready to change 2. Contemplation - Plans to change 3. Preparation - Prepares an action plan 4. Action – Currently making change 5. Maintenance – Strives to prevent relapse

Answer 37

**R -** Roll with Resistance - introduce change strategies **E –** Express Empathy – often, accurately, with effective reflection **D –** Develop Discrepancy – between patient’s goals and behavior **S –** Support Self-Efficacy – express confidence in patient’s abilities **O -** Open questions (can’t be answered with yes/no) **A -** Affirming (patient’s character/values, things they have done well) **R -** Reflecting (“sounds like…” guess at feeling, meaning, affect) **S –** Summarize (“what I hear you saying is…and we talked about… and the plan is…”

Answer 38

* Resistance to asking for help * Disdain of labels (alcoholic, old) * Lack of transportation * No significant others to assist in motivation to seek help * Providers less likely to refer older adults * Gaps in substance abuse, aging, and mental health services

Answer 39

* Attention paid to age-related issues (e.g. illness, depression, loss) * Consistent linkage with medical services * Staff with geriatric training * Avoid condescension and respect patient’s views on spirituality, swearing, etc. * Longer treatment duration, slower pace * Less confrontation and probing for “private” information * Accommodate sensory and cognitive declines in educational components * Groups are especially helpful in reducing shame and improving social network * Preparation for AA is important due to high level of confrontation * Less use of self-help jargon

Exam 2 - Study Material Flashcards

(64 cards)