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80 years old can be an important cut-off |
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a set of symptoms that occure together |
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syndromes may or may not be related to |
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a specific medical condition |
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not all patients will have a problem with |
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Beers criteria medications |
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some medications may have |
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potential risk or better alternatives |
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all benzos can have significant |
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can be an issue for elderly patients |
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intermediate acting benzos that are LESS likely to accumulate |
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lorazepam, temazepam, oxazepam |
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preferred long-acting benzo that has less accumulation |
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newer overactive bladder meds that are more selective for the bladder (DONT cross the BBB) |
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trospium (Sanctura) and Glycopyrrolate (Robinul) |
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1 TCA's are considered to be preffered |
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TCA's with reduced anticholinergic effect |
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nortriptyline and disipramine |
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second generations antihistamines are less of an issue |
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loratadine/ desloratadine, fexofenadine, cetirizine/ levocetirizine |
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very potent antihistamine that is often "hidden" in some OTC products |
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new anti-histamine agents |
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not effective for some conditions |
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Dopamine blockes mostly used for |
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anti-nausea and anti-psychotic (hallucinations) |
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metoclopramide and prochloperazine (Compazine) |
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is the affected drug dose likely to be |
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excessive or too low to cause an interaction? |
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specialists may be more inclined to use |
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higher doses than recommended |
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metformin induced lactic acidosis |
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is rare but can be serious or fatal |
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watch for change in diuretic or potassium |
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without a change in the other |
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usually monitored frequently when on K+ wasting diuretic/ ACE inhibitor |
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common SE's of anticholinergics |
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dry mouth/eyes, constipation, urinary retention, tachycardia |
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American Geriatrics Society HbA1C target |
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<8 may be appropriate for some patients |
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HYVETT study blood pressure target |
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<150/80 may be appropriate for patients 80 and older |
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decreasing cholesterol may |
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increase non-cardiovascular dealths in older patients (>80 yr old) |
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evidence-based screening tool to detect prescribing omissions in elderly patients |
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patients may start on osteoporosis medication |
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but do not take Ca and vit D |
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often appropriated to start medication below normal adult starting dose |
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may still need to increase dose however, geriatric patients need more time to tolerate medication |
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