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N421 Midterm (Polypharm, Musculo, Sleep, & Sensory) questions with correct answers
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N421 Midterm (Polypharm, Musculo, Sleep, & Sensory) questions with correct answers
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N421 Midterm (Polypharm, Musculo, Sleep, &Sensory) questions with correct answers
how can you promote drug adherence in an older adult? Correct
Answer-- listen & establish trust
- educate
- assess specific challenge (I.e. financial, complexity, lack of
understanding)
- advise they keep a current list of meds & bring it with them
- med organizers
- use an activity as a reminder (I.e. take meds after walking dog in the
morning)
- set alarms/sticky notes
- establish a routine
- keep meds visible
what are risks older adults have in relation to meds? Correct Answer--
ARCs (attention, relevance, competency)
- polypharm
- chronic conditions
how is absorption different in older adults? Correct Answer-- dec GI
motility
- inc gastric pH
- use of antacids, PPIs, & anticholinergics
,how is distribution different in older adults? Correct Answer-- dec in
body water --> inc the conc of water soluble meds when they are in the
body (can cause toxicity)
- inc in body fat --> inc volume creates a prolonged half life for soluble
meds
- dec in albumin (serum proteins) --> inc the toxicity of protein bound
meds
how is metabolism different in older adults? Correct Answer-- dec liver
blood flow & size --> delays/dec metabolism and inc half life
- inc toxicity with first pass drugs
- CYP450 is slowed --> warfarin & phenytoin levels will inc
how is excretion different in older adults? Correct Answer-- dec renal
blood flow
- dec GRF (by up to 50% by 90)
- inc toxicity forr renally excreted meds
- NSAIDS dec renal blood flow & function
what age related changes occur in the body? Correct Answer-- inc drug
receptor sensitivity to: anticholinergics, antihistamines, barbiturates,
benzos, digitalis, warfarin
- dec drug receptor sensitivity to: amphetamines, beta blockers,
quinidine
- visual/hearing dec
,- changes in cog function inc risk of anticholinergic effects & CNS
adverse effects
how do cardiac diseases impact drugs in the body of an older adult?
Correct Answer-impaired CO can dec distribution, metabolism, &
excretion
how do kidney & liver diseases impact drugs in the body of an older
adult? Correct Answer-can dec drug clearance & metabolism
how do neurological diseases impact drugs in the body of an older adult?
Correct Answer-- impaired cerebral blood flow
- greater sensitivity to CNS effects
what is polypharm? Correct Answer-taking 5+ meds at once (includes
supplements, herbs, and OTC)
what are contributors to polypharm? Correct Answer-- prescribing
cascade
- multiple conditions
- inc OTC meds
- recent/frequent hospitalizations
- uncoordinated care
what are risks of polypharm? Correct Answer-- inc hospitalizations
, - geriatric syndromes
- adverse drug evens
- duplication of drug therapy
- poor adherence
- cost
- dec QOL
how can polypharm be prevented? Correct Answer-- prevented use of
PMIs
- BEERS criteria
- deprescribing
- pt communication/education
- med reconciliation
- med management interventions
what are ADEs (adverse drug events)? Correct Answer-- injury from a
med
- drug-drug interactions
- drug-disease interactions
- drug-food interactions
what are risk factors for ADEs? Correct Answer-- starting a new
med/inc dose
- 6+ chronic diseases
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