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Geriatrics > 7. Medicine > Flashcards

7. Medicine Flashcards

1
Q

The body percentage of extracellular water (increases/decreases) with aging… intracellular water?

A

stays same… decreases

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2
Q

Age alters what two aspects of drug effects

A
  • Pharmacokinetics

- Pharmacodynamics

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3
Q

Define pharmacodynamics and pharmacokinetics

A

Pharacokinetics
-How the body processes the drug after administration (how the body affects the drug)

Pharmacodynamics

  • How the body reacts to the drug at receptor sites
  • How drug affects the body
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4
Q

What are the five elements of pharmacokinetics

A 
L= liberation 
A= Absorption 
D= Distribution 
M=MEtabolism 
E=Excretion
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5
Q

What factors influence pharmacodynamics

A
  • Receptor status
  • Genetic factors
  • Drug interactions
  • Drug tolerance
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6
Q

Factors that influence absorption are

A
  • Alterations in GI function
    • Reduced motility
    • Increased pH
    • reduced first-pass effect
  • Use of concomitant meds
    • pH changes
    • reducing absorption
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7
Q

Aspect of PK least affected by aging

A

Absorption

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8
Q

Describe distribution

A

Where the drug goes after it enters the blood

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9
Q

Factors that influence distribution

A
  • Reductions in protein binding
  • Increased % body fat
  • Decreased muscle
  • Decreased total body water
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10
Q

Two main organs of drug metabolism are

A

liver

kidney

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11
Q

First pass metabolism (increases/decreases) with age

A

decreases due to reduced liver function

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12
Q

How can you measure kidney function

A

GFR

-Creatinine clearance (Cockcroft-Gault equation)

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13
Q

Factors that influence PD

A
  • Distribution to biopahse (site of action reached?)
  • Receptor affinity
  • Receptor number
  • Post-receptor events
  • Homeostatic control mechanisms
  • NO generalizations
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14
Q

Examples of antiplatelet agents

A
  • Clopidogrel (plavix)
  • Aspirin
  • Ticagrelor
  • Prasugrel
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15
Q

Examples of anticoagulant drugs

A
  • Warfarin
  • Pradaxa
  • Eliquis
  • Xarelto
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16
Q

Patients most likely on anti-coagulants are

A

atrial fibrilation

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17
Q

Other brugs of caution for bleeding

A
  • NSAIDs
  • SSRI/SNRI
  • Omega 3 fatty acid
  • Herbals (garlic, cordyceps, saw palmetto)
18
Q

Effect of NSAIDs on bleeding

A

reversible inhibition of platelet aggregation

19
Q

Effect of SSRI/SNRI on bleeding

A

may impair platelet agg.

20
Q

Effect of Omega 3 FA on bleeding

A

Prolong bleeding time (potentially

21
Q

What drug results in irreversible inhibition of platelet agg.

A

aspirin

22
Q

Aging results in changes to

  • CNS clearance
  • BBB permeability
A

decrease…increase

23
Q

Commonly used classes of drugs for sedation are

A
  • Induction agents
  • Muscle relaxants
  • Anesthetic gases
24
Q

Considerations for sedation are

A
  • Postop delirium (POD)

- POstop cognitive dysfunction (POCD)

25
Q

POD and POCD lasts how long

A 
POD= 24-72 hrs
POCD= weeks to months
26
Q

How to reduce risks of sedation

A
  • Choice of sedative (short duration action)
  • Slow titration
  • Shortest duration possible
27
Q

Rule of thumb for sedation

A

reduce intiial dose by 50% in geriatic patients over 70 yrs old

28
Q

Strategies for healthy perscribing

A
  • Treat indications not symptoms
  • Weigh risks and benefits
  • Know patients health history and meds they are taking
  • Simplify regimen avoid PRN and monotherapy
  • Educate patients about effects both therapeutic and toxic
  • Consider new symptoms may be drug induced
29
Q

Sympathetic nervous system stimulates (thick/thin) saliva production. Patients on anti-cholinergic meds will have (thick/thin) saliva

A

Sympathetic= thick PSNS= thin

-Anti-cholinergics –> thick saliva

30
Q

Common xerogenic drug classes

A
  • Anti-histamines
  • Anti-hypertensives(alpha agonists and blockers and beta blockers)
  • Anti-psychotics
  • Bronchodilators (anti-muscarinics, and beta agonists)
  • Decongestants
  • Opioid
31
Q

Which will have worse xerostomia (1st/2nd) gen antihistmaines and why

A

1st becasue they penetrate the BBB

32
Q

Pilocarpine and cevimeline are what kinds of drugs

A

cholinergic agonist (muscarinic agonist)

33
Q

Uses for pilocarpine and cevimeline are

A
  • Uncontrolled asthma
  • Glaucoma
  • Iritis
34
Q

Caution should be taken when using pilocarpine and cevimeline in what patients

A
  • Active cardiac disease
  • Biliary tract disease
  • hepatic disease
35
Q

Side effects of pilocarpine and cevimeline

A
  • Sweating
  • Flushing
  • Dizziness
  • Rhinitis
  • Increased urinary freq
36
Q

Use of amifostine is

A

xerostomia prophylaxis (acute and chronic)

37
Q

Does amifostine negativelt affect cancer treatment

A

no

38
Q

Indications for amiforstine

A
  • Patients undergoing radiation (xerostomia prophy) for head/neck cancer
  • Radiation includes substantial portion of the parotid glands
39
Q

Amifostine is administered how

A

IV

40
Q

Adverse effects of Amifostine

A

hypotension

neusea and vomitting

Geriatrics (11 decks)

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