BEERS Alternatives
Alternatives to this medication category include nasal saline, nasal antihistamines, mast cell stabilizers, topical antihistamine, artificial tears, fexofenadine (least sedating even at high doses)
What are first generation antihistamines?
Two ways you can diagnosis Osteoporosis.
What are
1. Fragility Fracture
2. T-score < or = -2.5 at any site
3. FRAX score ?
Risk factors for developing Behavioral and Psychosocial Symptoms of Dementia (further referred to a BPSD). [name 4]
What are Lack of stimulation, New environment or caregiver, Pain, Caregiver Stress, Infection, Sensory Impairments, Polypharmacy, Thirsty/Hungry, or Tired?
This affects 25-50% of older adults with diabetes, often a side effect of overtreatment
What is hypoglycemia?
Can manage "overtreatment" with deprescribing, deintensification, simplification- modified glycemic goals
The American Geriatric Society STRONGLY supports continued research on the health of these older individuals as "evidence drives progress"- which stands in direct contrast to the current climate at NIH.
Who are LGTQI+ older adults?
Context: 5/4/25- nearly half of the NIH grants terminated were related to LGBTQI+ research
AGS recommends data collection- standardized and universal collection of SOGI data, importance of longitudinal studies and registries, partnership with community-based organizations.
This company- which brews 12 different styles of beer- is the world's largest dedicated NA brewery with breweries in Milford, CT and San Diego, CA.
What is Athletic Brewing Co?
This is the class of osteoporosis medications where a "holiday" or pause in treatment is appropriate.
What are Bisphosphonates?
The other classes of osteoporosis treatments do not allow for a pause in treatment due to rapid loss of bone mass (denosumab, anabolic therapies).
This is one model for assessing and managing BPSD. It is an acronym.
What is "DICE": Describe, Investigate, Create, Evaluate.
This geriatric syndrome is a recognized complication of DM, nearly 2x as likely.
What is dementia? (also depression)
Rec to screen at least annually for geriatric syndromes, hypoglycemia, polypharmacy that may affect DM management and diminish quality of life.
Considered one of the rarest jewels on the planet, natural pearls occur in wild oysters with this frequency.
What is 1 in 10,000?
During Prohibition Anheuser Busch and Pabst were some of the first to create this rhyming nickname for beer with an ABV of less than 0.5%.
What is "near beer"?
This is the time to benefit for treatment of osteoporosis with bisphosphonate therapy as compared to anabolic agents (PTH analogs, Romosozumab).
What is approximately 12 months for bisphosphonates and as early as 6 months for anabolic agents.
The most effective of these 3 medications in treating BPSD: (A) high-dose citalopram, (B) valproic acid, or (c) aripiprazole.
What is aripiprazole?
Aripiprazole and quetiapine are the best-tolerated second-generation antipsychotics used for BPSD.
High-dose citalopram is the only SSRI with proven benefit (minimal) in BPSD. Valproic acid is ineffective for isolated BPSD.
Defined as "shaped like, or having the form of a tree".
What is "DendriforM"?
(Regarding ethics of decision making) The pyramid of surrogate decision making is comprised of: Advanced Directives, Substituted Judgment, and Best Interests. This is the definition of "substituted judgment".
What is "steping into the shoes to make decisions (not necessarily what the surrogate would want), trying to approximate autonomy."?
This is the first-line treatment for insomnia, if not effective on its own can consider low-dose doxepin (up to 6mg), dual orexin receptor antagonists, or ramelteon. (Insufficient evidence for trazodone, mirtazapine and melatonin)
What is Cognitive Behavioral Therapy for Insomnia (CBT-I)?
Insomnia Coach digital CBT-I app http://mobile.va.gov/app/insomnia-coach (*free*)
SleepEZ https://veterantraining.va.gov/insomnia (*free*, computer based)
If a patient is on denosumab (Prolia) for over 2.5 years and it is discontinued, they should start a ________ and continue for _________ years.
If on denosumab for >2.5 years, patients should be on an oral bisphosphonate for 2-5 years to prevent bone mass loss (or receive at least 2 doses of zoledronic acid).
If on denosumab for under 2.5 years, patients should be on a bisphosphonate for 1-2 years (or receive at least 1 dose of zoledronic acid).
This non-pharmacologic treatment had the greatest impact on BPSD symptoms.
What is exercise?
The worst one of these in American History occurred on April 14, 1935 and was dubbed "Black Sunday".
What is "DuststorM"?
Eligibility criteria for the use of SGLT-2s in HFrEF or HFpEF for cardiorenal protection in older adults.
[name 1]
What is eGFR >20, plus stable volume status and bp?
Dose: empagliflozin or dapagliflozin 10mg qam.
IF euvolemic consider decreasing loop diuretic 20-50% on day 1 to avoid hypotension.
These words form the mnemonic "SCREeN" which reminds to evaluate non-urologic causes before reaching for medications to treat nocturia.
What are "Sleep (OSA, RLS), CV (CHF), Renal, Endo (DM), Neuro (PD)"?
This type of imaging can be used to identify atypical femur fractures (AFF) up to 9 years before an AFF occurs.
What is an extended femur scan using a DXA?
Takes under 2 minutes for the scan and can show risk for atypical femur fracture mostly through cortical thickening.
Best used for patients on long-term antiresorptive tx (denosumab, bisphosphonates)
A novel way to address BPSD during care transitions (example, transfer of patient with BPSD from long-term care to hospital).
What is a "Memory Transitional Care Plan" (will show example).
The goal TIRs for older adults- which highlight the complexities around deprescribing.
What are a TIR of 70% (hypo < 4%) for healthy older adults, and TIR of 50% for complex older adults (<1%)?
Individualization is KEY-no universal threshold for "overtreatment".
Kokichi Mikimoto is credited as the first man to create a cultured (or cultivated) pearl after nearly two decades of trial-and-error, he received a patent for cultured pearls in this year.