Polypharmacy in Elderly Patients

Polyuria is excessive urination (>3 liters/day for adults), Main causes include diabetes insipidus (DI), diabetes mellitus (DM), primary polydipsia (PP), and drug-induced ______

What is the focus of polypharmacy?

Polypharmacy is about providing treatment for medically necessary conditions while balancing inappropriate medications and undertreatment. It is important to avoid therapies with no indication, ineffective, therapeutic duplication, or causing harm/adverse effects.

Physical examination including vital signs, hydration status, neurological assessment, and ______ examination

Adverse drug reactions account for _____ of hospital admissions for older adults.

What are some common adverse reactions to medications in elderly patients?

Urinalysis for glucose, blood, protein, and specific ______

Inappropriate medication use can cause delirium, orthostatic hypotension, falls, fractures, urinary incontinence/retention, fecal incontinence/retention, and renal impairment. Common medication causes include warfarin, antiplatelet agents, insulin, and oral hypoglycemic agents.

What is the most common medication cause of adverse drug reactions in elderly patients?

Purpose of Water Deprivation Test is to differentiate between ______ and PP

What pharmacokinetic change occurs in elderly patients with regards to absorption of medications?

Elderly patients experience changes in pharmacokinetics due to increased body fat, longer half-life for lipophilic drugs, decreased metabolism, and decreased renal elimination.

What pharmacokinetic change occurs in elderly patients with regards to metabolism of medications?

Elderly patients have decreased sensitivity to beta-adrenergic agents like carvedilol and beta-agonists like salbutamol.

Precautions for Water Deprivation Test: conduct under supervision due to ______ risk

Treatment for Polyuria varies by cause, including desmopressin for DI, insulin therapy for DM, fluid restriction for PP, and medication adjustment for drug-induced ______

What pharmacodynamic change occurs in elderly patients with regards to sensitivity to sedative medications?

One common cause of adverse drug reactions in elderly patients is the use of _____ medications like diazepam or lorazepam.

Elderly patients have increased sensitivity to anticholinergic medications like oxybutynin and antithrombotic medications like warfarin.

What is undertreatment in elderly patients?

Furosemide is a ______ diuretic

Undertreatment can occur in elderly patients when important treatments are withheld. Commonly underprescribed therapies include ACE inhibitors for diabetes and proteinuria, anticoagulants for atrial fibrillation, and antihypertensives for uncontrolled hypertension.

Mechanism of action of Furosemide: inhibits sodium-potassium-chloride co-transporter in the Loop of Henle, reduces water ______

What is a commonly underprescribed therapy for uncontrolled hypertension in elderly patients?

Elderly patients may experience decreased sensitivity to beta-blockers like carvedilol.

What pharmacokinetic change occurs in elderly patients with regards to elimination of medications?

Spironolactone is an ______ antagonist

Mechanism of action of Spironolactone: competitive binding of receptors at aldosterone-dependent potassium exchange in the distal convoluted renal ______

What is the most commonly underprescribed therapy for atrial fibrillation in elderly patients?

Elderly patients have longer elimination time for drugs that are renally eliminated, such as gliclazide, sitagliptin, and gabapentin.

What pharmacodynamic change occurs in elderly patients with regards to sensitivity to beta-adrenergic agents?

Levothyroxine can cause polyuria and urinary frequency when it causes ______, downregulation of aquaporin 1 and 2, increased blood pressure and food and water intake, increased distal delivery of sodium resulting in increased urine flow

Pharmacodynamic changes in elderly patients can cause increased sensitivity to sedative medications, anticholinergic medications, and antithrombotic medications.

Dose adjustment considerations for Levothyroxine: perform lab work for thyroid-stimulating hormone (TSH), reduce the levothyroxine dose if TSH is ______

What is a commonly underprescribed therapy for post-MI or heart failure patients in elderly patients?

Vitamin D and calcium supplementation is commonly underprescribed in elderly patients at risk for osteoporosis.