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ACCP-Geriatrics
ACCP Geriatrics review
37
Pharmacology
Professional
05/05/2011

Additional Pharmacology Flashcards

 


 

Cards

Term

 Assement of aging

Measurement of function is preferred

function types

(3)

Definition

Physical  function = evaluated through one's ability to comple bsic and instrumental activities of daily living (ADL's and IADL's). Also screened for falls with instruments to evaluate gait and balance

 

Mental function = evaluated with mental status exams and addtional screens for

depression

 

Medical = evaluation of pat's med regimen

Term

Physiologic Changes with age that may change pharmacokinetics.

(GI, skin, body compostion,liver,renal)

Definition
Insert table for page 33
Term

Absorption changes

with aging

(oral, transdermal)

 

Definition
  1. Iron, vit b12 & calcium decreased with hypo or achlorhydria. 
  2. Most drugs ar absorbed by passive diffusion without sig changes with aging
  3. Transdermal formulations often require a subcut fat layer to for drug reservoir for absorbtion.
Term

Metabolism

changes with aging

Definition
  1. Morphine and propranolol are substantially reduced because of reduction in 1st pass metabolism
  2. Changes in metabolism through phase I (oxicdative) and cyp 450 enzymes are variable and confounded by age,sex, concomitant drugs and genetics.
Term

Elimination

changes with aging

Definition

  1. cockcoft-Gault most accepted method for est crcl in the elderly
  2. Four-variable mod of diet in renal disease equation is the most accpeted method  to estimate gfr for dianosing chronic kid disease
  3. Dose med as needed using est renal function
Term

Distribution

alterations with aging

Definition
  1. Lipid soluble benzos have increased half-life
  2. Highly albumin bound drugs such as phenytoin may have larger fraction of free drug (less albumin in elderly)
  3. Basic drugs such as propranolol may have decreased free fraction because of changes in glycoprotien concentrations
  4. p-glycoprotein, an efflux tansporter for the brain may be decreased with aging, which may lead to higher brain concentrations
Term
Four-variable MDRD formula
Definition

eGFR=

186 * (serum creat)-1.154 * (age)-0.203  * (0.742 if female) * (1.210 if african american)

Term

Function and Medications

Mobility

3 areas

Definition

  1.  Bone and Muscle integrity
  2. Balance/dizziness/falls
  3. extrapyramidal symptoms

 

Term

Mobility

Bone and Muscle integrity-Meds that impair

Definition

  1. Glucocorticosteroids
  2. long term use of ppi
  3. phenytoin

Term

Mobility

Bone and Muscle integrity-Interventions that promote function

Definition

 

  1. Vitamin d
  2. calcium
  3. bisphosphonates

 

Term

Mobility

Balance/dizziness/falls-Interventions that promote function

Definition
reduce polypharmacy
Term

Mental state

meds that impair function

Definition

anticholinergics

antimuscarinic

benzos

pentazocine

skeletal muscle relaxants

tricyclics, esp amitryptyline

gastrointestinal antispasmodics

anihistamines, esp diphenydramine

 

Term

Mental state

Interventions that promote function

 

Definition
Cholinesterase inhibitors (CIs)
Term

Emotional

Drugs that may impair function

Definition

Methyldopa

reserpine

anastrozole

interferon

tamoxifen

Term

Emotional state

Interventions that may promote Function

Definition
Appropriate use of antidepressants
Term

Continence

Drugs that may impair function

Definition

Anticholinergics

alpha-blockers

alpha-agonists

Term

Most common types of dementia

(4)

Definition

Alzheimer's

Lewey Body dementia

vascular causes of dementia

Pick's disease

Term
Common reversible causes of mental status changes
Definition

Alcohol abuse

normopressure hydrocephalus

thyroid dysfunction

Dehydration and electrolyte distrubance

vit B-12 deficiency

medications

Term

Medications that commonly cause mental status changes in the elderly

 

Definition

Anticholinergics and drugs with    anticholinergic  properties

Narcotics

Glucocorticosteroids

Benzos and sedative/hypnotics

some NSAID's

Term

Common assessment instruments used for Alzheimer's disease.

Mental state assessment (MMSE)

(2)

Definition

Folstein MMSE - range 0-30, higher scores indicate better mental functioning

 

ADAS-cog (Alzheimer's desease assessment scale-cognitive) - range 0-70, higher scores indicate better mental functioning.

Term
Common assessment instruments used for Alzheimer's disease-Function
Definition

Katz ADL's

Various scales to measure IADL's

Term
Common assessment instruments used for Alzheimer's disease-Behavior
Definition

Neuopsychiatric inventory- NPI ranges from 10-120, higher scores indicate more severe behavior problems

 

Behavioral pathology in Alzheimer's disease -ranges from 0-75 with higher scores indicate more behavioral problems

 

 

Term

Folstein Mini-Mental State Exam

ranges

Definition

Mild 20-24          loss of IADL's

Moderate 10-19   needs assit with ADL's

Severe <10         Dependency in basic ADL

Term

Alzheimer Meds

2 types

Definition

Cholinesterase inhibitors

Glutamatergic therapy

Term

Alzheimer's Disease Meds-Cholinesterase Inhibitors

(3)

Definition

Donepezil-aricept

Rivastigmine-Exelon

Galantamine-Razadyne

Term

Alzheimer's Disease meds

Cholinesterase inhibitors

Donepezil

(starting dose,maint dose,dosage forms,stage indicated,comments)

Definition

Starting:   5mg

Maint:      10mg (up to 23mg)

Dosage forms: oral, ODt

Stage: mild, moderate, severe

Comments: Risk of Bradycardia,syncope.               May be use in combination with               Memantine.

Term

 

Alzheimer's Disease meds

Cholinesterase inhibitors

Galantamine

(starting dose,maint dose,dosage forms,stage indicated,comments)

 

Definition

 

Starting:   4mg bid

Maint:      8-12mg bid

               8-24mg ER daily

Dosage forms: tabs, soln, ER caps

Stage: ?

Comments: Risk of Bradycardia,syncope increased with higher dosages. Give with food.

 

Term

 

Alzheimer's Disease meds

Cholinesterase inhibitors

Rivastigmine

(starting dose,maint dose,dosage forms,stage indicated,comments)

 

Definition

 

Starting:  1.5 bid

              9mg patch (delivers 4.6mg/d)

Maint:      3-6mg bid  

             18m patch (delivers 9.5mg/d)

Dosage forms: capsules,soln,patch

Stage: mild, moderate (also mild-mod             dementia with parkinson's)

Comments: Risk of Bradycardia,syncope

          Cholinergic  adverse effects, n/v           and diarrhea more intense than 

         other CI's.

 

Term

 

Alzheimer's Disease meds

Glutamatergic Therapy

Memantine

(starting dose,maint dose,dosage forms,stage indicated,comments)


 

Definition

 

Starting:   5mg daily

Maint:      10mg bid

Dosage forms: tabs, soln

Stage:  moderate, severe

Comments: May use in combination with        donepezil, well tolerated, confusion        sometimes seen

 

Term

Alzheimer's treatment pearls

(7)

Definition

  1. Start with cholinesterase inhib in mild to mod affected patients.
  2. No cholinesterase inhib is proven to be  better than another.
  3. Results for memantine are similar to those for cholinesterase inhib, but only indicated in mod-severe.
  4. Patients usually have statistically sig changes in measures of cognition, gloabal assessment and occasionally ADL function. NOT usually clinically meaningful.
  5. Evaluate at 3-6 months for stabilization or improvement.
  6. Conflicting evidence for discontinuation of meds should a patient decline or become unresponsive to treatment.
  7. when prevention is no longer a therapeutic goal for a patient, consider discontinuing meds, a taper recomended for patients at higher doses. Rebound agitation may occur for the first 1-2 weeks.

Term

Dementia

Behavioral symptoms

2 types

Definition

Psychosis

Agitation

Term

Dementia 

Psychosis Behaviorial symptoms

(3)

Definition

Delusions

paranoia

Hallucinations

Term

Dementia

Agitation Behavioral symptoms

(4)

Definition

aggression and combativeness

hyperactivity (wandering & pacing)

Hyper-vocalization

disinhibition

Term
Dementia Behavioral Measurement Exams
Definition

NPI 144 scale

BEHAVE-AD 75 scale

CMAI 203 scale

higher the numer, more severe behavioral problems

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