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Pharm Exam 5 > 68: Geriatric Pharmacology > Flashcards

68: Geriatric Pharmacology Flashcards

1
Q

polypharmacy

A

greater than 5 drugs per week

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2
Q

leading causes of death

A

heart disease

cancer

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3
Q

“prescribing cascade”

A

drug –> side effect –> drug for the side effects –> side effect

avoid prescribing until test results confirm suspected diagnosis
start with low dose and titrate slowly
avoid starting multiple medications simultaneously

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4
Q

changes in body composition with aging

A

decreased total body water
decreased lean body mass

increased body fat

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5
Q

cardiovascular changes with aging

A

decreased myocardial sensitivity to b-adrenergic stimulation
decreased baroreceptor activity
decreased cardiac output

increased total peripheral resistance

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6
Q

liver changes with aging

A

decreased liver size

decreased hepatic blood flow

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7
Q

pulmonary changes with aging

A 
decreased respiratory m. strength
decreased chest wall compliance
decreased total alveolar surface
decreased vital capacity
decreased max breathing capacity
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8
Q

renal changes with aging

A 
decreased GFR
decreased renal blood flow
decreased filtration fraction
decreased tubular secretory function
decreased renal mass
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9
Q

skeletal changes with aging

A

decreased skeletal bone mass (ostopenia)

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10
Q

what the body does to a drug =

A

pharmacokinetics

  • absorption, distribution, metabolism, clearance/elimination
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11
Q

parameter least affected by aging

A

absorption

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12
Q

first pass metabolism is _______ with aging

A

reduced

lower dose requirement in elderly with drugs inactivated by first pass; higher dose requirement with prodrugs requiring activation by first pass liver metabolism (codeine, propranolol, enalapril, perindopril, simvastatin)

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13
Q

metabolism/clearance is ______ with aging

A

reduced

reduced liver function and blood flow; reduced kidney function

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14
Q

volume of distribution =

how does it change in elderly?

A

amount of drug in body/ plasma drug concentration

large Vd - drug distributing to extravascular compartments, low Vd - drug staying in blood

more fat - higher volume of distribution for lipophilic drugs

less muscle - drugs like digoxin that bind to muscle will have decreased volume of distibution

less water in elderly - hydrophilic (gentamicin) drugs have decreased volume of distribution

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15
Q

half life =

equation

A

0.693 x vd / CL

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16
Q

would a highly lipid soluble drug have an increased or decreased half life in an elderly pt when compared to younger pt?

A

increased half life

water soluble - there will be less of an increase in half life than lipid soluble drugs because decrease in water balanced by reduction in clearance

17
Q

would the loading dose of a highly water soluble drug be larger or smaller in an elderly pt when compared to a young pt?

A

loading dose = (Vd x target concentration) / bioavailability

smaller *

18
Q

CL clearance =

A

Q x E

Q - flow rate to organ
E - extraction ratio

19
Q

with aging in liver; ______ activity of phase I enzymes (p450) and ________ activity of Phase III ensymes

A

reduced;
normal

no change in elderly pts hepatic clearance of a capacity limited drug if it metabolized by phase II enzymes; decreased if phase I

flow rate limited drugs have reduced hepatic clearance in elderly pts

therefore … No change in maintenance dose for capacity limited drugs metabolized by phase II enzymes; decrease in maintenance dose in capacity limited drugs that are phase I and in flow rate limited drugs

20
Q

how does tubular secretion change in elderly?

A

polypharmacy increases risk of drugs competing for active transporters (less secretion -more drug stays in body)

21
Q

index of glomerular filtration rate

A

creatinine

increases in plasma creatinine levels indicate a decrease in GFR

22
Q

accounts for decreased m. mass in elderly pts

A

cockcroft and gault equation

even with decreased GFR, elderly can have same plasma creatinine concentration due to decreased m. mass

23
Q

most significant parameters that increase half life of drugs in elderly

A

decreases in hepatic and renal clearance

lipophilic drugs have an even further increase in half life because Vd is increased in elderly

reminder: takes 4-5 half lives to reach steady state plasma concentration OR for a drug to be eliminated

24
Q

what the drug does to the body =

A

pharmacodynamics

in general, homeostatic control mechanisms are decreased in elderly

25
Q

____ responsiveness of elderly individual to hypotensive effect of beta blockers

A

decreased

26
Q

acute blood pressure response to calcium channel blockers is ______ in elderly

A

exaggerated

reduced baroreflex activation with aging

27
Q

aging ______ sensitivity to anesthetic agents

A

increases

thought to be due to altered expression of opiate receptors

28
Q

NSAIDs are dangerous in elderly…

aspirin, ibuprofen, etc.

A

cleared primarily by kidney

Cause renal damage because NSAIDs block increase in prostaglandins that normally would help to increase the blood flow and GFR in elderly kidney

also cause GI bleeding and irritation

29
Q

adverse effects of anticholinergic drugs in elderly

A 
dry mouth
decreased gut motility
bladder hypotonia
decreased cognition
sedation
orthostatic hypotension
blurry vision

increases overall risk form falls, impaired cognition = functional decline!

30
Q

anticholinergic drug classes to watch out for

A 
anticonvulsant
antidepressant (TCAs) 
antihistamine
antipsychotic
cardiovascular
GI antispasmodics
H2 antagonists
muscle relaxants
PD
Urinary antispasmodics
vetigo
31
Q

should you use first or second gen antihistamines with elderly?

A

second gen

first gen have anticholinergic properties that cause adverse side effects

Pharm Exam 5 (11 decks)

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