Older adults (65 & older) are more ____ to drugs and more ____ occur
- sensitive
- ADR’s
Objective is to ____ symptoms and improve _______
- reduce
- quoality of life
How is abortion altered in older adults?
2 answers
- rate is slower d/t delayed gastric emptying
- reduced gastric acidity
How is distribution altered?
4 answers (1 increased, 3 decreased)
- increased body fat %
- decreased lean body mass %
- decreased total body water
- reduced serum albumin
How is metabolism altered with age?
2 answers
- hepatatic drug metabolism declines
- half-life may be increased
How is excretion altered with age?
1 answer
- progressive decline in early adulthood
Pharmacodynamics in older age
- receptor alterations (beta andrenergic agents less affective)
ADR is ____x more common in older adults
- 7
Predisposing factors not directly related to age
6 answers
- drug accumalation
- polypharmacy
- severe illness
- comorbidities
- individual drug variation (adr)
- poor patient adherence (59% do not take as prescribed )
Avoid dabigatran for long term treatmetn of nonvalvular afib or VTE d/t
- increase risk GI bleed
Avoid prasurgel and ticagrelor d/t
- increae of major bleeding compared to clopidogerl (75 and older)
Avoid antidepressants:
Mirtazipine, SNRI, SSRI, TCA
Antiepileptics:
carbamazepine, oxacarbaxepine
Antipsychotics, Diuretics, Tramadol d/t
3 answers
- exacerbation
- cause SIADH
- hyponatremia
* monitor na levels
Avoid dextromethorphan-quinidine
- limited efficinecy w/ behavioral sx of dementia
- increase risk of falls
Avoid trimethoprim-sulfamethoxazole
- increased risk of hyperkalemia when used w/ ACEI, ARB and ARNI when decreased CrCL
Avoid sodium glucose cotransporter-2 (SGLT2) inhibitors: canigliflozin, dapagliflzoin, emplaglifozin, ertugliflozin d/t
- increased urofenital infections
- diabetic ketoacidosis
Factors that increase risk of ADR’s
8 answers
- multiple chronic disorders, prescriptions, doses
- difficult drug packaging
- multiple prescribers
- drug regimen changes
- cognitive or physical impariement
- recent hospital discharge
- inabilty to pay/ thinks drugs is uncessary
- SE
Measures to reduce ADR’s
6 answers
- ask provider to simplify drug regimen and dose
- clear, concise treatment: oral/written plan and explantion
- suggest pill diary, calendar, counter
- ask pharamsit to incrase label font and provide easy package
- ask patient about finace, refer to GoodRx
- monitor for ADR, Therapetic response, plasma drug level
End of life goal
- shifts from disease prevention to comfort measure
End of life therapy should ____ unnecessary medications
- decrease
Pharmacological considerations
5 answers
- constipation: osmotic lax
- Delerium: antipsychotics (haloperidol/ olanzapine)
- Dyspnea: o2 (hypoxia); opiods (1st line tx)
- Pain: fentanyl or methadone SCHEDULED
- Respiratory secretions: anticholinergics
adult medication adminstration: put, crush, place
- Put: put pills in applesauce or pudding
- Crush: crush/half pills into tbls of applesause (1st check if med can be crushed!)
- Place: place pills on tongue, tilt chin toward chest, swallow with water while head is bent
