Term
| glucose is necessary for many body functions |
|
Definition
| including primary fuel source for the brain |
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|
Term
|
Definition
| can take 8-10 years for benefit |
|
|
Term
| glucose lowering in geriatrics |
|
Definition
| may impact quality of life less and other co-morbidities may be more crucial |
|
|
Term
| older patients may not benefit as much from |
|
Definition
| intensive glucose lowering |
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|
Term
| consider patients ability to utilize |
|
Definition
| glucose lowering medications (safety of administrations/ understanding of hypoglycemia treatment) |
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|
Term
|
Definition
| <8 for geriatric patients; different targets with co-morbidity relations |
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|
Term
|
Definition
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|
Term
| Fasting BG of 80mg/dL should be the minimum |
|
Definition
| rather than a range of 70-80 |
|
|
Term
| can use higher end of standard goals of |
|
Definition
| 80-120 for fasting BG target |
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|
Term
| may need to tolerate some higher sugars |
|
Definition
| to avoid hypoglycemia (variations are inevitable); risk of falling is much greater here |
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|
Term
| short term hypoglycemic events can potentially be very serious |
|
Definition
| contributes to fall risk, may cause patients to avoid medications all together |
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|
Term
| lower glucose (<70 mg/dL) that does not cause hypoglycemic symptoms |
|
Definition
| may damage heart and result in increased mortality (newer research) |
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|
Term
|
Definition
| most long-acting sulfonylureas and has most hypoglycemic events; DON'T USE IT in elderly |
|
|
Term
| long-acting sulfonylureas |
|
Definition
| more likely to cause hypoglycemia because it is less likely to match food intake |
|
|
Term
| other sulfonylureas that are preferred |
|
Definition
|
|
Term
| oral diabetic medications that do NOT increase insulin release (less hypoglycemia) |
|
Definition
| metformin, glitazones (pioglitazone, rosiglitazone), alpha glucosidase inhibitors (acarbose/miglitol) |
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|
Term
|
Definition
| titrate slowly (may need weeks/ months between dose increases for some) |
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|
Term
| HYVETT trial for patients 80+ |
|
Definition
| <150/80 is reasonable for BP; some will allow more tolerance with diastolic <90 |
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|
Term
| pressure needed for vital organs |
|
Definition
|
|
Term
| fall may be more common problem from |
|
Definition
|
|
Term
| organ insufficiency and falls may |
|
Definition
|
|
Term
| some experts debate the presence of J-curve |
|
Definition
| not found in all research, randomized/ controlled trial lacking |
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|
Term
|
Definition
|
|
Term
| isolated systolic hypertention |
|
Definition
| ateries less flexible as heart pumps (more common in elderly) |
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|
Term
| must be careful with vasodilators (lowers pressure at rest and contractions) |
|
Definition
| isolated systolic hypertention |
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|
Term
| anti-hypertensives preferred for isolated systolic hypertention |
|
Definition
| diuretics (HCTZ), CCB: verapamil/ diltiazem (watch HR) and DHP's can also be used |
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|
Term
| factors that reduce blood pressuer (few) |
|
Definition
| medications, dehydration, medical conditions |
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|
Term
|
Definition
| not a priority for elderly patients |
|
|
Term
|
Definition
| can help with cardiac remodeling in SYSTOLIC heart failure |
|
|
Term
| in many cases medications for CHF |
|
Definition
| will still be used similarly in geriatric patients as they would for younger patients |
|
|
Term
| prevention of bad cardiac remodeling |
|
Definition
| ACE inhibitors/ARBs, B blockers, and spironolactone |
|
|
Term
| beta blockers can worsen SYSTOLIC heart failure |
|
Definition
|
|
Term
| must watch for blood pressure decreas |
|
Definition
| not all CHF patients will have HTN, use highest dose the patient can tolerate |
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|
Term
|
Definition
|
|
Term
|
Definition
| need 2-3 years to see benefit |
|
|
Term
| statin therapy if patients > or equal to 80 years, some debate |
|
Definition
| may result in possible increase in non-cadiovascular mortality, but likely still beneficial for Cardiovascular mortality |
|
|
Term
|
Definition
| likely 3 years for benefit, debate rearding the need for continued treatment beyond 5 years |
|
|
Term
| follow-up after 5 years of bisphos use |
|
Definition
| has shown some decrease in BMD but not necessarily increase in fractures |
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