Age differences in pharmacology

Question 1

Most drug response changes in elderly are _____ related changes

Answer 1

Pharmacokinetics

Question 2

Does absorption change with age?

Answer 2

Largely unchanged, but variability increased

Question 3

With age, do polar drugs have larger or smaller Vd?

Answer 3

Smaller (higher drug concentrations in the blood)

Question 4

With age, do nonpolar drugs have larger or smaller Vd?

Answer 4

Larger (prolongs half life)

Question 5

Does protein binding change with age?

Answer 5

May not change with aging but may in pathology (albumin often decreases with kidney function)

Question 6

Does biotransformation change with age?

Answer 6

Highly variable, but increased duration of biotransformed drugs due to reduced phase I metabolism

Question 7

Does elimination change with age?

Answer 7

Yes, increased duration of renally-excreted drugs

Question 8

Criteria for potentially inappropriate medication use in older adults
Based on potential impact on elderly patients alone or in combination with other drugs

Answer 8

Beers criteria

Question 9

What is the Beers criteria?

Answer 9

Criteria for potentially inappropriate medication use in older adults

Question 10

Problem in the elderly that includes using medications without indication, duplicate medications in the same drug category or class, interacting meds, drugs contraindicated for the patient, or drugs to treat the effects of another drug

Answer 10

Polypharmacy

Question 11

Term for: born before 37 weeks gestational age

Answer 11

Premature

Question 12

Term for: 1 day to 1 month old

Answer 12

Neonates

Question 13

Term for: 1 month to 1 year old

Answer 13

Infants

Question 14

Term for: 1 year to 11 years old

Answer 14

Children

Question 15

Term for: 12-16 years old

Answer 15

Adolescent

Question 16

Gastric pH at birth

Answer 16

6-8

Question 17

Gastric pH in 24 hours of birth in full term infants

Answer 17

1-3

Question 18

This pH is elevated in premature infants

Answer 18

Gastric pH

Question 19

Emptying time in premature infant

Answer 19

Slow
Increased bioavailability due to increased contact time

Question 20

Intramuscular absorption in premature infants requires adjustment for these 4 things

Answer 20

Relative muscle mass
Variable perfusion rate
Vasomotor instability
Low muscle tone/activity

Question 21

Type of absorption that is increased in newborns

Answer 21

Percutaneous
Due to underdeveloped epidermal barrier and elevated skin hydration

Question 22

Potential problem with percutaneous absorption in newborns

Answer 22

Increased permeability may increase toxicity

Question 23

Body fat is low in neonates compared with adults, so ______ soluble drugs will have smaller volumes of distribution

Answer 23

Lipid

Question 24

________ soluble drugs will have larger volumes of distribution in pediatric patients, especially during the first year

Answer 24

Water

Question 25

Is protein binding increased or decreased or unchanged in infants?

Answer 25

Decreased
Lower plasma protein concentration so risk of ‘free’ drug toxicity is greater

Question 26

These are described as “little water bags”

Answer 26

Neonates
Fetus/infants have much higher proportion of extracellular water and total body water than adults

Question 27

Phase I biotransformation reactions reach adult levels at this point

Answer 27

Between 5 months and 5 years

Question 28

Phase II biotransformation reactions reach adult levels at this point

Answer 28

Within 6 months
Are very limited at birth