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  • Benzodiazepines, barbiturates
  • : warfarin, theophylline, phenytoin, digoxin
  • 200 300 400 500 100

    1. 1. 200 300 400 500 100 200 300 400 500 100 200 300 400 500 100 200 300 400 500 100 200 300 400 500 100 “ Inappropriate” Medications Aging Physiology ACOVE Indicators ADE & Underutilization Geriatric Prescribing Pearls
    2. 2. This is the commonly referred to name of the expert consensus opinion regarding potentially inappropriate medication use in the elderly.
    3. 3. What is the Beer’s list?
    4. 4. The reason diphenhydramine is listed as potentially inappropriate.
    5. 5. What are it’s highly anticholinergic side effects?
    6. 6. The reason benzodiazepines are listed as potentially inappropriate
    7. 7. What is their potential to exacerbate delirium/ confusion? OR What is their association with falls/ hip fracture?
    8. 8. The reason meperidine is listed as potentially inappropriate, independent of diagnosis
    9. 9. What is its poor efficacy for pain control? OR What is the high risk of side effects from active metabolites (confusion, lowering of seizure threshold)?
    10. 10. A component of common over the counter cold medications that is potentially inappropriate in the setting of hypertension
    11. 11. What is pseudoephedrine?
    12. 12. This pharmacodynamic property does not change substantially with aging, except in the presence of certain medications or comorbidities.
    13. 13. What is absorption?
    14. 14. As we age, this happens to our body water, changing the volume of distribution for certain medications
    15. 15. What is decrease?
    16. 16. As we age, this happens to our body fat, changing the volume of distribution for certain medications Bonus name a common medication that this change affects
    17. 17. What is increase?
    18. 18. As we age, our renal function is reduced, being affected by age, serum creatinine, and this additional factor
    19. 19. What is weight in kilograms? (Cockcroft Gault equation)
    20. 20. As we age, this may happen to plasma protein concentration. Bonus name a med that may have an increased concentration due to this effect
    21. 21. What is decrease?
    22. 22. The ACOVE medication quality indicators cover several broad categories. These include prescribing indicated medications, medication monitoring, education/ documentation, medication monitoring, and this fourth category.
    23. 23. What is avoiding inappropriate medications?
    24. 24. In the hospital, if an older adult is prescribed a new medication, then this should be in the chart.
    25. 25. What is a clearly defined indication?
    26. 26. If a vulnerable older adult is prescribed a new medication for a chronic condition, this is the time frame in which in which there should be documentation of response to therapy.
    27. 27. What is six months?
    28. 28. If a vulnerable older adult is newly prescribed an ACE-I, then their serum creatinine and potassium should be checked within this time frame.
    29. 29. What is one month?
    30. 30. If a vulnerable older adult is prescribed warfarin, an INR should be checked at least this frequently after the initial monitoring.
    31. 31. What is every six weeks?
    32. 32. Cardiovascular medications, anticogulants, NSAIDS, and this group of medications account for most of the adverse drug events in older adults.
    33. 33. What are psychotropic meds, antibiotics, or anti- seizure medications?
    34. 34. This is the name of the phenomenon by which a symptom is not recognized as a medication side effect, then another medication is added to treat the effect and on and on…
    35. 35. What is the prescribing cascade?
    36. 36. There are multiple risk factors for an older adult to have a medication related problem. Name one.
    37. 37. What is age >/= 85, 6 or more active chronic conditions, low creatinine clearance, low body weight, nine or more medications, more than twelve doses of medications per day, and previous adverse drug reaction
    38. 38. Underutilization of data supported medications in older adults is also an issue. Common underutilized medications include ACE-I in congestive heart failure, anti-resorptive medications in osteoporosis, and this other medication/ indication.
    39. 39. What are anticoagulants in atrial fibrillation?
    40. 40. Adverse drug reactions contribute to hospitalization in this percentage of persons older than 80.
    41. 41. What is 25%?
    42. 42. Anytime an older adult presents with a new or unexplained condition, you should consider this as a cause.
    43. 43. What is an adverse drug event?
    44. 44. Aim for a “brown bag” medication review, including herbals, at least this often.
    45. 45. What is annually?
    46. 46. At the time of hospital discharge, these two processes regarding medications are particularly important.
    47. 47. What is medication review comparing prior outpatient medications to discharge medications and medication review with the patient/ family?
    48. 48. Name a major cause of non-adherence to a medication regimen.
    49. 49. What is cost, complexity of regimen, swallow/ memory problems, difficulty reading instructions or opening bottle, side effects (ie diuretics)
    50. 50. This is a major axiom regarding medication initiation that you may hear from geriatricians.
    51. 51. What is “start low, go slow”

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