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 pharmacists, we evaluate medications looking for potential contribuing factors such as hypoglycemia, hypotension, dizziness, etc.
What are falls?
These changes in the GI tract can affect oral absorption of medications. (Name at least 1)
What are decreased gastric acid production (increased pH) and slowed gastric emptying time?
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?
These agents are less effective in geriatric patients due to decreased beta receptors.
What are beta-blockers?
Topical agents, such as fentanyl patches, may have different effects on geriatric patients because of these ADME 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?
The use of NSAIDs can lead to these 2 serious ADRs in geriatric patients.
What are GI bleeds and AKI?
This physiologic change can affect volume of distribution and lead to accumulation of certain medications. It is more common in post-menopausal females.
What is increased adipose tissue (body fat)?
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?
Free Space!
Are you the lucky one?
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?
***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?
This underlying change present in geriatric patients can cause an abnormally low value for the laboratory marker of renal function, SCr. This is often the reason for rounding SCr up to 1.0 or 0.8 when calculating CrCl.
What is a decrease in overall muscle mass?
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)?
Geriatric patients require lower doses of opioids (even those that aren't eliminated renally) because of this pharmacodynamic change.
What is increased response to mu receptor agonism?
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 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)
Renal function is often decreased in geriatric patients due to these changes. (Name at least 1)
What are decreased GFR, decreased renal blood flow, and decreased tubular secretion?
The AGS created this list to help identify drugs that are potentially inappropriate in the elderly.
What is the Beers Criteria?
Due to this decreased biological response, geriatric patients are at a higher risk of orthostatic hypotension.
What is impaired baroreceptor reflex?
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?
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?
Hepatic function in geriatric patients is generally ______ when compared with non-geriatric adults.
What is "the same"? (Hepatic impairment is not associated with the normal changes of aging. If hepatic impairment is present it is likely due to a specific condition, similar to hepatic dysfunction in younger adults).
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?