Geriatrics(AMERICAN BOARD)

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

Pediatrics (AMERICAN BOARD)

Pediatrics

Kirsten H. Ohler, Pharm.D., BCPS, BCPPS

University of Illinois Hospital & Health Sciences System Chicago, Illinois

Learning Objectives

1.       Describe the most common pathogens associated with neonatal and pediatric sepsis and meningitis.

2.       D escribe current therapeutic options for the management of neonatal and pediatric sepsis and meningitis.

3.       I dentify the drugs available for preventing and treating respiratory syncytial virus.

4.       D escribe the most common causative organisms of otitis media and potential treatment options.

5.       I dentify the recommended pediatric immunization schedule and barriers to routine immunization.

6.       Discuss the differences in anticonvulsant pharma-cokinetics and adverse effects between children and adults.

7.       Describe the current drug therapy for treatingpatients with attention-deficit/hyperactivity disorder.

Self-Assessment Questions

Answers and explanations to these questions can be found at the end of this chapter.

1.       A 15-year-old boy with a history of exercise-in-duced asthma presents with fever, tachypnea, headache, and myalgia. Which is most likely to be isolated from this patient?

A.      Respiratory syncytial virus (RSV).

B.      Streptococcus pneumoniae.

C.      Group B Streptococcus.

D.      Pseudomonas aeruginosa.

2.       W hich is the best assessment of the risk of severe RSV infection and subsequent need for prophylaxis in a 3-month-old girl born at 30 weeks’ gestation?

A.      T his patient should receive prophylaxis if she is 6 months or younger at the beginning of RSV season.

B.      This patient is at risk only if she has chronic lung disease (i.e., necessitating more than 21% oxygen for at least the first 28 days of life).

C.      All neonates born during RSV season should receive prophylaxis.

D.      T his patient should receive prophylaxis only if she has additional risk factors such as day care attendance or school-aged siblings.

3.       W hich is the most accurate statement about prophylaxis of bacterial meningitis?

A.      C lose contacts of patients with pneumococcal meningitis should receive prophylaxis.

B.      C lose contacts of patients with Haemophilus influenzae meningitis need prophylaxis only if their immunizations are not up to date.

C.      Rifampin is a first-line agent for prophylaxis against meningococcal meningitis.

D.      Prophylaxis against bacterial meningitis is no longer recommended regardless of the causative organism.

4.       A 6-month-old baby who was born at 24 weeks’ gestation is brought to the clinic in October for a routine checkup and immunizations. Which is the best recommendation to make for this patient’s immunization schedule?

A.      O nly two of the five immunizations due should be given at the same time; schedule another appointment for the next week to administer the rest.

B.      O ral polio vaccine should be used to reduce the number of injections needed to complete the schedule.

Vaccines should be based on his corrected ges-tational age rather than on his

تحميل الملف كاملا 

Drug Interactions Checker

Type in a drug name and select a result from the list. Repeat the process to add multiple drugs. When complete, save your list for future reference or check for interactions immediately

.One of the first duties of the physician is to educate the masses not to take medicine.” The oft-quoted aphorism from renowned medical teacher William Osler is a warning about the potential side-effects of both prescribed and over- the- counter medication. An Institute of Medicine report estimated there were between 230,000 and 284,000 treatment induced deaths in the US annually.

The particular risk of drug interactions was highlighted recently in Dublin Coroner’s Court. Coroner Myra Cullinane heard evidence suggesting a 48-year-old woman’s death may have been caused by the combined use of Lemsip and paracetamol tablets. The victim was probably not aware that Lemsip contains paracetamol, leading to a verdict of misadventure. An autopsy gave the cause of death as acute liver failure with cumulative paracetamol use as a possible contributory factor.

Older adults are at especially high risk of drug–drug interactions because of the prevalence of polypharmacy. Age-related changes in the function of the body’s organs that affect the efficient clearance of drugs from the system are also a major factor. One study found that about 15 per cent of older people living in the community were at risk of a drug–drug interaction in the period 2010-2011 – a doubling in risk from five years previously. Recent research has focused on important interactions involving particular types of drugs: statins ( used to treat high cholesterol); calcium channel blockers (for the treatment of heart disease); and blood thinning agents (like warfarin and newer oral anticoagulants).

Medications that interact with statins and increase the risk of statin toxicity include the antibiotic clarithromycin and a range of antifungal agents. Drugs that cause warfarin to be less effective include a number of anti-epilepsy drugs.

But there is a particular need for the public to be aware of the interaction potential of herbal medicines with prescribed medication. Our use of over-the-counter drugs would also benefit from a sharper focus.

استقصاء حول توافر شبكة انترنت في الادارات الصحية والمخازن والوحدات التابعة

الدخول لرابط تسجيل الاستقصاء

يرجي الدخول على اللينك وتسجيل البيانات
يرجى تحري الدقي في تسجيل البيانات