Geriatric Pharmacotherapy
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Questions and Answers

What is the primary concern associated with polypharmacy in geriatric patients?

  • Increased therapeutic effect
  • Higher risk of adverse drug reactions (correct)
  • Reduced healthcare costs
  • Improved patient compliance

    • A prescribing cascade occurs when:

  • A patient's medication is discontinued due to a side effect
  • A new medication is added to a patient's regimen to treat a side effect of another medication (correct)
  • A patient's medication is switched to a generic equivalent
  • A patient's medication is adjusted due to a change in diagnosis

    • The Beers Criteria is a set of guidelines used to:

  • Avoid potentially inappropriate medications in geriatric patients (correct)
  • Monitor medication adherence in geriatric patients
  • Optimize medication dosing in geriatric patients with renal impairment
  • Identify potential medication-related falls in geriatric patients

    • Which of the following is a potential consequence of polypharmacy in geriatric patients?

    <p>Increased risk of falls</p> Signup and view all the answers

    What is the primary goal of deprescribing in geriatric patients?

    <p>To simplify medication regimens and reduce polypharmacy</p> Signup and view all the answers

    What is the term for the use of multiple medications, often leading to adverse interactions and poor health outcomes?

    <p>Polypharmacy</p> Signup and view all the answers

    A patient is prescribed a medication to treat the side effects of another medication. What is this phenomenon known as?

    <p>Prescribing cascade</p> Signup and view all the answers

    What is the primary purpose of the Beers Criteria?

    <p>To identify medications that are inappropriate for geriatric patients</p> Signup and view all the answers

    Which of the following is a potential consequence of a prescribing cascade?

    <p>Increased risk of adverse effects</p> Signup and view all the answers

    In geriatric pharmacotherapy, what is the primary goal of reducing the number of medications used?

    <p>To minimize the risk of adverse effects</p> Signup and view all the answers

    What is polypharmacy in geriatric patients?

    <p>The simultaneous use of multiple medications</p> Signup and view all the answers

    What is a prescribing cascade?

    <p>When a new medication is prescribed to treat the side effects of another medication</p> Signup and view all the answers

    What is the primary purpose of the Beers Criteria?

    <p>To identify high-risk medications for geriatric patients</p> Signup and view all the answers

    What is a potential consequence of polypharmacy in geriatric patients?

    <p>Increased risk of adverse drug interactions</p> Signup and view all the answers

    Why is deprescribing important in geriatric patients?

    <p>To reduce the risk of adverse drug interactions and improve patient outcomes</p> Signup and view all the answers

    How do age-related physiological changes affect drug absorption in elderly patients?

    <p>Decrease blood flow to the gut, reducing absorption</p> Signup and view all the answers

    What is the effect of age-related changes on drug distribution in elderly patients?

    <p>Decreased lean body mass, leading to decreased volume of distribution</p> Signup and view all the answers

    How do age-related changes affect drug metabolism in elderly patients?

    <p>Decrease hepatic metabolism, reducing drug clearance</p> Signup and view all the answers

    What is the effect of age-related changes on drug excretion in elderly patients?

    <p>Decrease glomerular filtration rate, reducing drug excretion</p> Signup and view all the answers

    How do age-related changes affect pharmacodynamics in elderly patients?

    <p>Decrease receptor sensitivity, reducing drug response</p> Signup and view all the answers

    How do age-related changes in gastrointestinal function affect drug absorption in elderly patients?

    <p>Decrease the rate of absorption</p> Signup and view all the answers

    What is the effect of age-related changes on plasma protein binding of drugs in elderly patients?

    <p>Increased protein binding, leading to higher free drug concentrations</p> Signup and view all the answers

    How do age-related changes in hepatic function affect drug metabolism in elderly patients?

    <p>Decrease the rate of metabolism</p> Signup and view all the answers

    What is the effect of age-related changes on renal function and drug excretion in elderly patients?

    <p>Decrease the rate of excretion</p> Signup and view all the answers

    How do age-related changes affect pharmacodynamics in elderly patients?

    <p>Increase the sensitivity to drug effects</p> Signup and view all the answers

    How do age-related changes in gastrointestinal function affect drug absorption in elderly patients?

    <p>Decrease bioavailability of drugs</p> Signup and view all the answers

    What is the effect of age-related changes on plasma protein binding of drugs in elderly patients?

    <p>Decrease plasma protein binding</p> Signup and view all the answers

    How do age-related changes in hepatic function affect drug metabolism in elderly patients?

    <p>Decrease the activity of cytochrome P450 enzymes</p> Signup and view all the answers

    What is the effect of age-related changes on renal function and drug excretion in elderly patients?

    <p>Decrease renal blood flow and glomerular filtration rate</p> Signup and view all the answers

    How do age-related changes affect pharmacodynamics in elderly patients?

    <p>Increase the sensitivity to drug effects</p> Signup and view all the answers

    What is the effect of age-related changes in gastrointestinal function on drug absorption in elderly patients?

    <p>Decreased absorption due to decreased gut motility and reduced splanchnic blood flow</p> Signup and view all the answers

    How do age-related changes in hepatic function affect drug metabolism in elderly patients?

    <p>Decreased metabolism due to decreased hepatic enzyme activity</p> Signup and view all the answers

    What is the effect of age-related changes on plasma protein binding of drugs in elderly patients?

    <p>Decreased binding due to decreased albumin levels</p> Signup and view all the answers

    How do age-related changes affect pharmacodynamics in elderly patients?

    <p>Increased sensitivity to medications due to increased receptor sensitivity</p> Signup and view all the answers

    What is the effect of age-related changes on renal function and drug excretion in elderly patients?

    <p>Decreased excretion due to decreased renal blood flow and glomerular filtration rate</p> Signup and view all the answers

    What is the primary purpose of using the Beers Criteria in geriatric patients?

    <p>To identify potentially inappropriate medications</p> Signup and view all the answers

    What is the primary concern associated with polypharmacy in geriatric patients?

    <p>Adverse interactions and poor health outcomes</p> Signup and view all the answers

    What is the term for the use of multiple medications, often leading to adverse interactions and poor health outcomes?

    <p>Polypharmacy</p> Signup and view all the answers

    What is the goal of deprescribing in geriatric patients?

    <p>To reduce the number of medications used</p> Signup and view all the answers

    What is a prescribing cascade?

    <p>A medication prescribed to treat the side effects of another medication</p> Signup and view all the answers

    What is the primary benefit of using the Beers Criteria in geriatric patients?

    <p>Identifying potentially inappropriate medications</p> Signup and view all the answers

    What is the main concern when using multiple medications in geriatric patients?

    <p>Adverse interactions and poor health outcomes</p> Signup and view all the answers

    What is the consequence of a prescribing cascade in geriatric patients?

    <p>Adverse interactions and poor health outcomes</p> Signup and view all the answers

    Why is deprescribing important in geriatric patients?

    <p>To reduce the risk of adverse drug events</p> Signup and view all the answers

    How do age-related physiological changes affect drug therapy in elderly patients?

    <p>They alter the absorption, distribution, metabolism, and excretion of drugs</p> Signup and view all the answers

    What is the main objective of the Beers Criteria?

    <p>To identify potentially inappropriate medications for elderly patients</p> Signup and view all the answers

    Which of the following is a potential consequence of polypharmacy in geriatric patients?

    <p>Adverse drug events and poor health outcomes</p> Signup and view all the answers

    What is the goal of deprescribing in geriatric patients?

    <p>To reduce the number of medications used</p> Signup and view all the answers

    What is a prescribing cascade?

    <p>A patient is prescribed a medication to treat the side effects of another medication</p> Signup and view all the answers

    Why is deprescribing important in geriatric patients?

    <p>To reduce the risk of adverse drug events</p> Signup and view all the answers

    What is the main objective of the Beers Criteria?

    <p>To identify potentially inappropriate medications for elderly patients</p> Signup and view all the answers

    What is the primary concern associated with polypharmacy in geriatric patients?

    <p>Adverse interactions and poor health outcomes</p> Signup and view all the answers

    What is a prescribing cascade?

    <p>A medication used to treat the side effects of another medication</p> Signup and view all the answers

    What is the goal of deprescribing in geriatric patients?

    <p>To reduce the number of medications used</p> Signup and view all the answers

    Why is deprescribing important in geriatric patients?

    <p>To improve health outcomes by reducing medication interactions</p> Signup and view all the answers

    What age-related physiological changes should be considered when deciding on drug choice and dose adjustments in geriatric patients?

    <p>All of the above</p> Signup and view all the answers

    How do age-related changes in renal function affect drug excretion in elderly patients?

    <p>Decrease the excretion of water-soluble drugs</p> Signup and view all the answers

    What should healthcare providers consider when interpreting the implications of age-related physiological changes on drug therapy in geriatric patients?

    <p>All of the above</p> Signup and view all the answers

    How do age-related changes in liver function affect drug metabolism in elderly patients?

    <p>Decrease the metabolism of fat-soluble drugs</p> Signup and view all the answers

    What is the primary goal of considering age-related physiological changes when deciding on drug choice and dose adjustments in geriatric patients?

    <p>To reduce the risk of adverse drug interactions</p> Signup and view all the answers

    What is the primary consideration when deciding on a drug's dose for a geriatric patient?

    <p>The patient's age-related physiological changes</p> Signup and view all the answers

    How do age-related changes in gastrointestinal function affect drug absorption in elderly patients?

    <p>Decrease the rate of absorption</p> Signup and view all the answers

    What is the effect of age-related changes on plasma protein binding of drugs in elderly patients?

    <p>Increase the free fraction of the drug</p> Signup and view all the answers

    How do age-related changes in hepatic function affect drug metabolism in elderly patients?

    <p>Decrease the rate of metabolism</p> Signup and view all the answers

    What is the effect of age-related changes on renal function and drug excretion in elderly patients?

    <p>Decrease the rate of excretion</p> Signup and view all the answers

    Study Notes

    Geriatric Pharmacotherapy

    • Polypharmacy: The simultaneous use of multiple medications, increasing the risk of adverse drug interactions, and decreased medication adherence in older adults.

    Adverse Consequences

    • Prescribing Cascades: A series of events where a medication is prescribed to treat an adverse effect of another medication, leading to a cycle of additional medications and potential harm.

    Safe Prescribing Practices

    • Beers Criteria: A list of medications considered potentially inappropriate for older adults due to their high risk of adverse effects, such as sedatives, hypnotics, and anticholinergics.

    Key Considerations

    • Age-related changes: Older adults experience decreased renal and hepatic function, leading to altered drug metabolism and increased sensitivity to medication side effects.
    • Multimorbidity: Many older adults have multiple chronic conditions, requiring complex medication regimens and increasing the risk of polypharmacy and prescribing cascades.

    Geriatric Pharmacotherapy Concepts

    • Polypharmacy: The concurrent use of multiple medications by an individual, typically five or more, which increases the risk of adverse drug reactions, drug interactions, and decreased medication adherence.

    Polypharmacy Risks

    • Increased risk of adverse drug reactions (ADRs) due to drug-drug interactions and cumulative side effects
    • Decreased medication adherence due to complexities in dosing regimens and pill burden
    • Higher risk of hospitalizations, morbidity, and mortality in older adults

    Prescribing Cascades

    • Prescribing Cascade: A series of medications prescribed to treat the side effects of previous medications, leading to a cascade of inappropriate medication use
    • Examples: prescribing a medication to treat a side effect of another medication, rather than addressing the underlying issue

    Beers Criteria

    • Beers Criteria: A set of guidelines for potentially inappropriate medications (PIMs) to avoid in older adults due to higher risk of adverse effects, limited efficacy, or availability of safer alternatives
    • Criteria include medications with high anticholinergic properties, CNS active drugs, and medications with a high risk of falls or fractures

    Geriatric Pharmacotherapy Key Concepts

    Polypharmacy

    • Polypharmacy is the concurrent use of multiple medications by an individual
    • It is a common issue in geriatric patients, who often have multiple chronic conditions
    • Polypharmacy increases the risk of adverse drug reactions, drug interactions, and medication non-adherence

    Prescribing Cascades

    • A prescribing cascade occurs when an adverse drug reaction is mistakenly diagnosed as a new medical condition
    • This leads to the prescription of additional medications to treat the perceived condition
    • The prescribing cascade can result in a vicious cycle of polypharmacy and increased healthcare costs

    Beers Criteria

    • The Beers Criteria is a list of potentially inappropriate medications (PIMs) for older adults
    • Developed by Dr. Mark Beers, the criteria aim to reduce medication-related harm in geriatric patients
    • The list includes medications with high risks of adverse effects, drug interactions, or diminution of benefit in older adults

    Geriatric Pharmacotherapy Key Concepts

    • Polypharmacy: The concurrent use of multiple medications, often prescribed by different healthcare providers, increasing the risk of adverse drug interactions and reactions.
    • Prescribing Cascades: A process where a medication is prescribed to treat an adverse effect of another medication, leading to a cascade of subsequent prescriptions to treat additional adverse effects.

    Beers Criteria

    • A list of medications considered potentially inappropriate for older adults due to their high risk of adverse effects, interactions, and decreased efficacy in this population.
    • Criteria include medications with strong anticholinergic properties, those that exacerbate common geriatric conditions, and those with significant drug-drug interactions.
    • Absorption: Decreased gastrointestinal motility and blood flow can lead to altered drug absorption rates in elderly patients.
    • Distribution: Changes in body composition, including increased fat mass and decreased water content, can affect drug distribution and volume of distribution.
    • Metabolism: Age-related decline in liver function and cytochrome P450 enzyme activity can impact drug metabolism, leading to increased serum drug levels.
    • Excretion: Decreased kidney function can impair drug excretion, leading to accumulation and potential toxicity.

    Impact on Pharmacodynamics in Elderly Patients

    • Altered pharmacological response: Age-related changes in receptor density, receptor affinity, and signal transduction pathways can affect the efficacy and potency of medications.
    • Increased sensitivity: Elderly patients may be more susceptible to adverse effects due to age-related changes in pharmacokinetics and pharmacodynamics.
    • Dose adjustments: Consideration of age-related changes is essential when prescribing medications to elderly patients to minimize adverse effects and optimize therapeutic outcomes.

    Geriatric Pharmacotherapy

    • Polypharmacy: The concurrent use of multiple medications, often resulting in increased risk of adverse drug reactions, interactions, and decreased medication adherence.
    • Prescribing cascades: A series of events where a medication is prescribed to treat an adverse effect of another medication, leading to a cascade of additional medications and potential interactions.

    Beers Criteria

    • A set of guidelines developed by Mark Beers in 1991 to identify potentially inappropriate medications for use in older adults.
    • The criteria focus on medications that can cause harm, have limited efficacy, or have better alternatives.
    • Examples of medications included in the Beers Criteria include benzodiazepines, nonsteroidal anti-inflammatory drugs (NSAIDs), and anticholinergics.
    • Pharmacokinetics:
      • Absorption: Age-related changes in gut motility, blood flow, and gastric pH can affect drug absorption.
      • Distribution: Changes in body composition, such as increased fat mass, can affect drug distribution and half-life.
      • Metabolism: Decreased liver function and enzymatic activity can lead to reduced drug metabolism.
      • Excretion: Decreased renal function can lead to impaired drug excretion.
    • Pharmacodynamics: Age-related changes in receptor function, signal transduction, and homeostatic mechanisms can affect drug response and efficacy.
    • These changes can lead to increased sensitivity to medications, increased risk of adverse effects, and altered drug response in elderly patients.

    Geriatric Pharmacotherapy Concepts

    • Polypharmacy: The use of multiple medications, often by older adults, which can lead to increased risk of adverse drug reactions, interactions, and decreased medication adherence.
    • Prescribing Cascades: A series of events where a new medication is prescribed to treat an adverse effect of another medication, potentially leading to further adverse effects and additional medications.
    • Beers Criteria: A list of medications that are potentially inappropriate for older adults due to their potential for adverse effects, especially in those with certain health conditions.
    • Absorption: Decreased absorption of medications in elderly patients due to decreased gastric acid secretion, reduced gut motility, and increased pH levels.
    • Distribution: Changes in body composition, such as decreased lean body mass and increased fat mass, affecting the distribution of medications.
    • Metabolism: Decreased liver function and metabolism, leading to increased plasma concentrations of medications.
    • Excretion: Decreased renal function, leading to increased plasma concentrations of medications eliminated by the kidneys.
    • Pharmacodynamics: Altered response to medications in elderly patients due to changes in receptor affinity, density, and sensitivity, as well as decreased homeostatic mechanisms.

    Impact on Elderly Patients

    • Increased Risk of Adverse Effects: Age-related physiological changes can increase the risk of adverse effects, such as sedation, confusion, and falls, due to altered pharmacokinetics and pharmacodynamics.
    • Decreased Efficacy: Changes in pharmacokinetics and pharmacodynamics can also lead to decreased efficacy of medications in elderly patients.

    Geriatric Pharmacotherapy Concepts

    • Polypharmacy: The use of multiple medications, often by older adults, which can lead to increased risk of adverse drug reactions, interactions, and decreased medication adherence.
    • Prescribing Cascades: A series of events where a new medication is prescribed to treat an adverse effect of another medication, potentially leading to further adverse effects and additional medications.
    • Beers Criteria: A list of medications that are potentially inappropriate for older adults due to their potential for adverse effects, especially in those with certain health conditions.
    • Absorption: Decreased absorption of medications in elderly patients due to decreased gastric acid secretion, reduced gut motility, and increased pH levels.
    • Distribution: Changes in body composition, such as decreased lean body mass and increased fat mass, affecting the distribution of medications.
    • Metabolism: Decreased liver function and metabolism, leading to increased plasma concentrations of medications.
    • Excretion: Decreased renal function, leading to increased plasma concentrations of medications eliminated by the kidneys.
    • Pharmacodynamics: Altered response to medications in elderly patients due to changes in receptor affinity, density, and sensitivity, as well as decreased homeostatic mechanisms.

    Impact on Elderly Patients

    • Increased Risk of Adverse Effects: Age-related physiological changes can increase the risk of adverse effects, such as sedation, confusion, and falls, due to altered pharmacokinetics and pharmacodynamics.
    • Decreased Efficacy: Changes in pharmacokinetics and pharmacodynamics can also lead to decreased efficacy of medications in elderly patients.

    Geriatric Pharmacotherapy Key Concepts

    • Polypharmacy: The simultaneous use of multiple medications, increasing the risk of adverse drug interactions, and potential negative outcomes in elderly patients.
    • Prescribing Cascades: A series of events where a medication is prescribed to treat an adverse effect of another medication, leading to a cascade of additional medications and potential harm.

    The Beers Criteria

    • A set of guidelines for healthcare providers to identify potentially inappropriate medications (PIMs) for elderly patients.
    • Criteria consider factors such as medication efficacy, safety, and potential drug interactions in older adults.
    • Absorption: Decreased gastric acid secretion, slowed gastric emptying, and reduced gut surface area can affect drug absorption in elderly patients.
    • Distribution: Changes in body composition, decreased plasma albumin, and increased body fat can alter drug distribution and affect drug efficacy.
    • Metabolism: Decreased liver function, reduced renal clearance, and age-related changes in enzyme activity can impact drug metabolism and elimination.
    • Excretion: Decreased renal function, reduced glomerular filtration rate, and increased tubular reabsorption can affect drug excretion and lead to toxicity.
    • Pharmacodynamics: Age-related changes in receptor density, affinity, and responsiveness can alter drug efficacy and increase the risk of adverse effects.

    Identifying Potentially Inappropriate Medications

    • Use the Beers Criteria to identify medications that may be inappropriate for elderly patients due to their potential to cause harm, interact with other medications, or have limited efficacy.
    • Consider patient-specific factors, such as age, medical conditions, and current medications, when selecting medications for elderly patients.

    Geriatric Pharmacotherapy Concepts

    • Polypharmacy: The simultaneous use of multiple medications by an elderly patient, increasing the risk of adverse drug reactions, interactions, and decreased medication adherence.
    • Prescribing Cascades: A sequence of events where an adverse drug reaction is mistakenly diagnosed as a new medical condition, leading to the prescription of additional medications that can worsen the patient's condition.

    Beers Criteria

    • A list of potentially inappropriate medications (PIMs) for elderly patients, developed to improve medication safety and reduce adverse drug events.
    • The criteria are used to identify medications that should be avoided or used with caution in elderly patients due to their potential to cause harm or have limited efficacy.
    • Absorption: Decreased gastric acid secretion and slowed gastrointestinal motility can affect drug absorption in elderly patients.
    • Distribution: Age-related changes in body composition, such as increased fat mass and decreased lean body mass, can alter drug distribution.
    • Metabolism: Decreased liver mass, blood flow, and enzyme activity can affect drug metabolism in elderly patients.
    • Excretion: Reduced renal function can impact drug elimination, leading to potential toxicity.
    • Pharmacodynamics: Age-related changes in receptor sensitivity and signal transduction can affect drug efficacy and adverse effects.

    Using the Beers Criteria

    • The Beers Criteria are used to identify PIMs that can cause harm, have limited efficacy, or have safer alternatives.
    • Healthcare providers use the criteria to evaluate medication regimens and optimize therapy for elderly patients.

    Key Concepts in Geriatric Pharmacotherapy

    • Polypharmacy: the simultaneous use of multiple medications, increasing the risk of adverse drug reactions, drug-drug interactions, and decreased medication adherence in elderly patients.
    • Prescribing cascades: a cycle of prescribing additional medications to treat the adverse effects of previous medications, leading to further polypharmacy and potential harm.

    • Changes in drug pharmacokinetics:

      • Decreased absorption: altered gastrointestinal physiology and decreased gastric motility affecting oral drug absorption.
      • Altered distribution: changes in body composition, blood flow, and protein binding affecting drug distribution.
      • Slowed metabolism: decreased liver function and enzyme activity affecting drug metabolism.
      • Impaired excretion: decreased renal function affecting drug elimination.

    • Changes in drug pharmacodynamics:

      • Increased sensitivity to drug effects due to age-related changes in receptor density and function.
      • Decreased homeostatic responses, making elderly patients more susceptible to adverse drug reactions.

    Beers Criteria

    • A set of guidelines for identifying potentially inappropriate medications (PIMs) for elderly patients.
    • Criteria include:
      • Medications with high risk of adverse effects in elderly patients.
      • Medications with decreased efficacy in elderly patients.
      • Medications with safer alternatives available.

    Applying the Beers Criteria

    • Identify PIMs by reviewing medications that:
      • Have a high risk of sedation, hypotension, or bleeding.
      • Have anticholinergic or antihistaminic properties.
      • Are not recommended for use in elderly patients due to safety concerns.

    Key Concepts in Geriatric Pharmacotherapy

    • Polypharmacy: the simultaneous use of multiple medications, increasing the risk of adverse drug reactions, drug-drug interactions, and decreased medication adherence in elderly patients.
    • Prescribing cascades: a cycle of prescribing additional medications to treat the adverse effects of previous medications, leading to further polypharmacy and potential harm.

    • Changes in drug pharmacokinetics:

      • Decreased absorption: altered gastrointestinal physiology and decreased gastric motility affecting oral drug absorption.
      • Altered distribution: changes in body composition, blood flow, and protein binding affecting drug distribution.
      • Slowed metabolism: decreased liver function and enzyme activity affecting drug metabolism.
      • Impaired excretion: decreased renal function affecting drug elimination.

    • Changes in drug pharmacodynamics:

      • Increased sensitivity to drug effects due to age-related changes in receptor density and function.
      • Decreased homeostatic responses, making elderly patients more susceptible to adverse drug reactions.

    Beers Criteria

    • A set of guidelines for identifying potentially inappropriate medications (PIMs) for elderly patients.
    • Criteria include:
      • Medications with high risk of adverse effects in elderly patients.
      • Medications with decreased efficacy in elderly patients.
      • Medications with safer alternatives available.

    Applying the Beers Criteria

    • Identify PIMs by reviewing medications that:
      • Have a high risk of sedation, hypotension, or bleeding.
      • Have anticholinergic or antihistaminic properties.
      • Are not recommended for use in elderly patients due to safety concerns.

    Geriatric Pharmacotherapy

    • Polypharmacy refers to the use of multiple medications by an individual, which is common in older adults and can lead to adverse drug reactions and interactions.
    • Changes in pharmacokinetics with age:
      • Absorption: Decreased gastric acid secretion, reduced gut motility, and increased gastric pH can affect drug absorption.
      • Distribution: Body composition changes, including increased fat and decreased lean body mass, can affect drug distribution.
      • Metabolism: Decreased liver function and enzyme activity can impact drug metabolism.
      • Excretion: Decreased renal function can lead to drug accumulation and toxicity.
    • Changes in pharmacodynamics with age:
      • Altered receptor affinity and density can affect drug response.
      • Increased sensitivity to certain medications, such as benzodiazepines and anticholinergics.

    Prescribing Cascades

    • A prescribing cascade occurs when an adverse drug reaction is misdiagnosed as a new condition, leading to the initiation of a new medication, which can further exacerbate the problem.

    Beers Criteria

    • A set of criteria used to identify potentially inappropriate medications for elderly patients, including medications that:
      • Have a high risk of adverse effects in older adults.
      • Have a narrow therapeutic index or are difficult to withdraw.
      • Have a lack of evidence for efficacy or safety in older adults.
      • Can exacerbate common geriatric conditions, such as dementia, delirium, or falls.

    Drug Choice and Dose Adjustments

    • Considerations for drug choice and dose adjustments in geriatric patients:
      • Age-related changes in pharmacokinetics and pharmacodynamics.
      • Presence of multiple comorbidities and polypharmacy.
      • Use of the Beers Criteria to identify potentially inappropriate medications.
      • Need for close monitoring and dose titration to minimize adverse effects.

    Geriatric Pharmacotherapy Concepts

    • Polypharmacy: the simultaneous use of multiple medications by a patient, which increases the risk of adverse drug reactions, drug interactions, and decreased medication adherence.
    • Prescribing cascades: a sequence of events where a medication is prescribed to treat the side effect of another medication, leading to a cascade of medication use.
    • Beers Criteria: a list of potentially inappropriate medications for elderly patients, which helps healthcare providers avoid medications that may be ineffective or cause harm in older adults.
    • Changes in absorption: decreased gastric acid secretion, slower gastric emptying, and decreased jejunal surface area affect drug absorption in elderly patients.
    • Changes in distribution: decreased lean body mass, increased body fat, and decreased albumin levels affect drug distribution in elderly patients.
    • Changes in metabolism: decreased liver size, decreased liver blood flow, and decreased enzyme activity affect drug metabolism in elderly patients.
    • Changes in excretion: decreased renal function and decreased glomerular filtration rate affect drug excretion in elderly patients.
    • Changes in pharmacodynamics: decreased responsiveness to certain medications, increased sensitivity to medication side effects, and altered receptor binding in elderly patients.

    Beers Criteria Applications

    • Identify potentially inappropriate medications for elderly patients based on factors such as drug-drug interactions, side effect profiles, and dosing requirements.
    • Avoid medications with high risk of adverse effects, such as anticholinergics, benzodiazepines, and non-steroidal anti-inflammatory drugs (NSAIDs).
    • Decreased medication clearance and increased half-life in elderly patients require dose adjustments and monitoring for toxicity.
    • Age-related changes in receptor sensitivity and binding affect medication efficacy and side effect profiles.
    • Individualized medication regimens must consider age-related physiological changes to optimize therapeutic outcomes.

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    Description

    Explore key concepts in geriatric pharmacotherapy, including polypharmacy, prescribing cascades, and the Beers Criteria. This quiz covers essential topics in geriatric pharmacy practice and medication management.

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