Getting Older
These are examples of anticholinergic side effects (at least 2), which can be more profound in geriatric patients due to an increased sensitivity to antagonism of cholingergic receptors.
What are delirium, dry mouth, constipation, urinary retention?
Diphenhydramine is associated with this type of receptor-mediated side-effect, which typically calls for reducing to the lowest needed dose.
What are anticholinergic side effects?
This is a very serious adverse event that mulitidisciplinary teams are often seeking to eliminate. As physicians, we evaluate medications looking for potential contribuing factors such as hypoglycemia, hypotension, dizziness, etc.
What are falls?
When a patient presents to the ED with an acutely altered mental status, this lab is often ordered due to the possibility of this medical condition.
What is a urinalysis due to the possibility of a UTI?
The fear that if a geriatric patient is admitted to the hospital they may never return home again...
What is Loss of Independence?
This non neurologic disorder can mimic dementia with symptoms such as:
Confusion
Hallucinations
Combativeness
What is a Urinary Tract Infection (UTI)
This antibiotic is time-dependent and is eliminated renally. It is also correlated with acute kidney injury if not monitored closely. The half-life of this agent is typically longer in geriatric patients due to their decreased renal function.
What is vancomycin?
The use of NSAIDs can lead to these 2 serious ADRs in geriatric patients.
What are GI bleeds and AKI?
A side effect of antidiabetic management that results in the ADA/AGS recommending a more relaxed A1c goal in older adults, especially those with multiple comorbidities.
What is hypoglycemia?
The CDC lists cardiovascular disease, cancer and chronic respiratory diseases as some of these.
What is the Leading Causes of Death in Geriatric Patients?
Acute and fluctuating state, inability to focus, think logically and maintain attention that can be caused by hypoxia, hypovolemia, hypothermia or hypoglycemia.
What is delirium?
This cardiac drug has a narrow therapeutic index, has a specific toxicity syndrome, is eliminated renally, and has several documented drug-drug interactions. Geriatric patients can occasionally exhibit s/s of toxicity even at therapeutic levels.
What is digoxin?
***Daily Double*** Orthostatic hypotension is a term used to describe this effect on blood pressure. Systolic change of ___ or Diastolic change of ____ related to ___________. Must get ALL 3 for points.
What is a >20 mmHg drop in systolic or >10 mmHg drop in diastolic BP upon a change in position?
Chronic use of this GI medication class should be avoided due to risk of pneumonia, fractures and c. difficile.
What are PPIs (omeprazole, pantoprazole, lansoprazole)?
The most common type of fracture in older adults often resulting from a ground level fall.
What is a femoral neck fracture?
Condition causing slow onset of progressive, generally irreversible disorientation, shortened attention span ad loss of cognitive function. Signs and Symptoms can take months or years to become apparent.
What is dementia?
Topical agents, such as fentanyl patches, may have different effects on geriatric patients because of these ADME (absorption, distribution, metabolism, excretion) changes. (name at least 1)
What are ADME changes associated with decreased subcutaneous fat, decreased skin thickness, increased activity at opioid receptors, and decreased renal elimination?
This ADR is associated with a commonly-prescribed medication that reduces ASCVD risk is (arguably) more common in geriatric patients and rarely, if very severe, can be measured by CPK and SCr.
What is statin-induced myopathy? (very severe = rhabdomyolysis)
The AGS created this list to help identify drugs that are potentially inappropriate in the elderly.
What is the Beers Criteria?
This condition is a progressive disease of joints that destroys cartilage, promotes formation of bone spurs in joints and results in joint stiffness.
What is Osteoarthritis?
Due to this decreased biological response, geriatric patients are at a higher risk of orthostatic hypotension.
What is impaired baroreceptor reflex?
This combination medication is used for treating a common geriatric disease state associated with cognitive decline and motor dysfunction. In addition, it can contribute to orthostatic hypotension.
What is carbidopa/levodopa?
This term is used to describe treating a side effect from one medication with another medication. For example, using fludricortisone to treat orthostatic hypotension for a patient prescribed tamsulosin.
What is the prescribing cascade?
Geriatric patients often have a decreased sense of taste for these 2 tastes. This change can result in the overuse of these 2 food additives at mealtimes and can affect control of chronic diseases such as diabetes and heart failure. (Name the 2 tastes and the 2 additives)
What is increased use of salt and sugar due to decreased sense of sweet and salty?
Because an older patient's kidneys may not be able to handle unusual challenges during illness, patients may lose large amounts of sodium and other electrolytes before urinary production is halted. Coupled with a markedly decreased thirst mechanism this leaves your patient very susceptible to these 2 things.
What are Dehydration and Electrolyte Imbalances?