Geriatrics
Lisa C. Hutchison,
Pharm.D., MPH, BCPS, FCCP
University of Arkansas
for Medical Sciences
College of Pharmacy
Little Rock, Arkansas
Learning Objectives
1. Summarize common age-related pharmacokinetic and pharmacodynamic
changes in older adults.
2. E valuate the pharmacotherapeutic regimens of older adults to
support optimal risk and benefit of medications.
3. A ssess inappropriate medication prescribing in older adults
using accepted tools.
4. R ecommend appropriate pharmacotherapy for patients with
dementia.
5. E valuate the risks and benefits of antipsychotic use in older
adults with dementia.
6. Recommend appropriate interventions for patients with BPSD
(behavioral and psychological symptoms of dementia).
7. Differentiate between the types of urinary inconti-nence and
recommend appropriate treatments.
8. R ecommend an appropriate BPH (benign prostatic hypertrophy)
treatment based on the AUASI (American Urological Association Symptom Index).
9. R ecommend appropriate analgesic therapy for older adults with
osteoarthritis.
10. Discuss the risks and benefits of medication classes used to
treat rheumatoid arthritis and associated comorbidities.
Self-Assessment Questions
Answers and explanations to these questions
can be found at the end of this chapter.
Questions 1 and 2 pertain to the following case: An 85-year-old man
presents to the primary care clinic after the death of his spouse 1 month ago.
His medical history is significant for hypertension, hyperlipidemia, benign
prostatic hypertrophy (BPH), and major depressive disorder. His current
medications include lisinopril 10 mg daily, atorvastatin 20 mg daily,
tamsulosin 0.4 mg daily, diazepam 5 mg at bedtime as needed for sleep, and
escitalopram 10 mg daily. His daughter reports that he has been more lethargic
and unsteady walking during the past 3 days. The patient reports trouble
sleeping and taking diazepam every night this past week. His blood pressure is
135/72 mm Hg, and his heart rate is 76 beats/minute. Urinalysis was negative,
thyroid-stimulating hormone (TSH) was within the reference range, and Geriatric
Depression Scale (GDS) score was 6/15.
1. Which medication is contributing most to this patient’s lethargy
and confusion?
A. Diazepam.
B. Lisinopril.
C. Atorvastatin.
D. Escitalopram.
2. W hich age-related change in pharmacokinetics is most likely to
underlie this patient’s medication- related problem?
A. Delayed oral absorption.
B. Decreased renal excretion.
C. Slowed metabolism in the liver.
D. Decreased volume of distribution.
Questions 3–5 pertain to the following case:
A 76-year-old woman was recently admitted to a longterm care facility
for rehabilitation after multiple falls at home. Her medical history is
significant for hypertension, hypothyroidism, Alzheimer disease (AD),
hyperlipidemia, and osteoarthritis (OA). She currently takes metoprolol
succinate 50 mg daily, levothyroxine 75 mcg daily, atorvastatin 10 mg daily,
and donepezil 10 mg daily. Her BP is 126/80 mm Hg and heart rate is 66
beats/minute. Basic metabolic panel results were all within reference ranges; 25-hydroxy
vitamin D level was لتحميل الملف كاملا اضغط هنا
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