BCGP flashcards
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32 cards. Read the term and the definition here. The deck at the top of this page is optional.
- Cockcroft-Gault equation
- Estimates creatinine clearance from age, weight, and serum creatinine; multiply by 0.85 for females. Used to dose renally eliminated drugs in older adults despite normal serum creatinine.
- Homeostenosis
- Age-related reduction in physiologic reserve across organ systems. It explains why older adults decompensate rapidly under stress such as infection, dehydration, or surgery.
- Beers Criteria
- Consensus list of potentially inappropriate medications for adults 65 and older, organized by drug class, quality of evidence, and recommendation strength. It is decision support, not an absolute prohibition.
- Prescribing cascade
- When an adverse drug effect is misidentified as a new disease and treated with an additional drug, compounding risk. Example: amlodipine-induced edema treated with a diuretic.
- Delirium versus dementia
- Delirium is acute, fluctuating, and marked by inattention; dementia is chronic and progressive. Delirium frequently occurs in patients with underlying dementia, requiring medication review.
- CHA2DS2-VASc score
- Risk score for stroke in nonvalvular atrial fibrillation: congestive heart failure, hypertension, age, diabetes, stroke, vascular disease, and sex. Score ≥2 in men or ≥3 in women supports anticoagulation.
- HFrEF quadruple therapy
- Guideline-directed therapy combining an ARNI or ACE inhibitor/ARB, an evidence-based beta-blocker, a mineralocorticoid receptor antagonist, and an SGLT2 inhibitor to reduce mortality and hospitalization.
- Lenient rate control
- In atrial fibrillation, resting heart rate below 110 beats per minute is acceptable when symptoms and ventricular function are preserved. Stricter targets are reserved for persistent symptoms or cardiomyopathy.
- A1c targets in older adults
- ADA recommends <7.0–7.5% for healthy older adults, <8.0% for complex patients, and <8.5% for those with limited life expectancy or high hypoglycemia risk.
- Metformin renal thresholds
- Metformin requires dose reduction when eGFR is below 45 mL/min/1.73 m² and discontinuation below 30. Hold before iodinated contrast when eGFR is below 30.
- Levothyroxine initiation
- Start older adults, especially those with cardiac disease, at 12.5–25 mcg daily and titrate by TSH every 6–8 weeks to avoid precipitating angina or arrhythmia.
- Apathetic thyrotoxicosis
- Hyperthyroidism in older adults presenting without classic adrenergic symptoms, instead manifesting as atrial fibrillation, weight loss, or unexplained cognitive decline.
- Topical NSAID preference
- Topical NSAIDs are preferred over oral agents for localized knee or hand osteoarthritis because systemic absorption and GI, renal, and cardiovascular risks are substantially lower.
- Opioid initiation in older adults
- Start opioid-naive older adults at 25–50% of the usual adult dose, titrate slowly, and co-prescribe a bowel regimen to prevent constipation.
- Glucocorticoid-induced osteoporosis
- Bone loss occurs rapidly with glucocorticoid use exceeding three months. Assess fracture risk and consider calcium, vitamin D, and antiresorptive therapy.
- CURB-65
- Pneumonia severity score: confusion, urea above 7 mmol/L, respiratory rate ≥30, blood pressure low, and age ≥65. Higher scores guide site of care.
- Asymptomatic bacteriuria
- Bacteria in urine without urinary symptoms. It should not be treated in older adults except during pregnancy or before urologic procedures, to avoid resistance and C. difficile.
- COPD inhaled therapy
- Most symptomatic patients receive long-acting muscarinic antagonist plus long-acting beta agonist. Inhaled corticosteroids are added for frequent exacerbations or eosinophilic inflammation.
- Overactive bladder treatment
- Behavioral therapy first; antimuscarinics or beta-3 agonists next. In cognitive impairment, prefer beta-3 agonists because antimuscarinics worsen cognition and constipation.
- 5-alpha-reductase inhibitor effects
- These agents shrink prostate tissue over months, improve symptoms gradually, and lower prostate-specific antigen by roughly 50%, requiring interpretation adjustment for cancer screening.
- Long-term PPI risks
- Prolonged proton pump inhibitor use is associated with C. difficile infection, fractures, hypomagnesemia, and vitamin B12 deficiency, supporting periodic reassessment and deprescribing.
- STOPP/START criteria
- STOPP flags potentially inappropriate medications in older adults; START identifies indicated therapies that are omitted. Together they guide comprehensive medication review.
- Anticholinergic burden
- Cumulative exposure to drugs with anticholinergic activity. Higher burden is associated with cognitive decline, falls, constipation, and urinary retention in older adults.
- Deprescribing taper rule
- Benzodiazepines, opioids, beta-blockers, antidepressants, corticosteroids, and proton pump inhibitors require gradual tapering rather than abrupt discontinuation to avoid withdrawal or rebound.
- Orthostatic hypotension criteria
- A systolic drop of at least 20 mmHg or diastolic drop of at least 10 mmHg within three minutes of standing. Measure at one and three minutes after standing.
- Mini-Cog
- Brief cognitive screen combining three-item recall with clock drawing. It is quick, validated in older adults, and relatively unaffected by education or language.
- Teach-back method
- Asking patients to restate instructions in their own words to confirm understanding. It identifies low health literacy and reduces medication errors and readmissions.
- Transition of care bundle
- Discharge medication reconciliation, written instructions, and follow-up within seven days. These elements reduce preventable readmissions and medication discrepancies.
- OBRA antipsychotic rules
- Nursing home regulations require documented indication, target behavior, and periodic review for antipsychotics, plus gradual dose reduction attempts unless clinically contraindicated.
- Informed consent elements
- Capacity, disclosure of risks and alternatives, understanding, voluntariness, and authorization. All must be present for valid consent to treatment.
- Collaborative practice agreement
- A written arrangement between a pharmacist and prescriber that authorizes the pharmacist to adjust, monitor, or discontinue medications under defined protocols, varying by state law.
- Frailty phenotype
- Fried criteria: unintentional weight loss, exhaustion, weakness, slow gait, and low activity. Three or more criteria define frailty and predict adverse outcomes.