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Block: 1.15 > Day 3: Jayakumar Geriatric PK > Flashcards

Day 3: Jayakumar Geriatric PK Flashcards

1
Q

What are the three categories that define the “elderly”?

A
  1. Chronological (how old they actually are)
  2. Change in social role (something like retiring)
  3. Change in capabilities (losing ability to drive, take care of themselves)
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2
Q

Do all people have the same rate of decline as they age?

A

No, the rates of decline and disease state manifestation differ greatly between individuals

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3
Q

What is an elderly patients functional age depend on?

A
  1. Environment
  2. Physical abilities
  3. Cognition
  4. Comorbid conditions
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4
Q

What happens to geriatric patients in terms of body composition?

A

Total body water decrease

Lean body mass decreases

Albumin levels fall

Body fat will increase

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5
Q

What happens to the CNS as geriatric patients age?

A

Brain parenchyma size

Loss in cognition

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6
Q

What happens to the cardiovascular system as people age?

A

Baroreceptor activity starts to fall

Cardiac output drops

SA/AV node conduction time takes long with lowers heart rate

**these changes can cause older people to get dizzy and increase risk of falling

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7
Q

What happens to the liver of patients when they age?

A

Hepatic blood flow decreases

Liver parenchyma size (liver gets smaller)

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8
Q

What happens to GI of patients as they age?

A

Absorption decreases

Has delayed gastric emptying

Gastric PH changes (increases)

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9
Q

What happens to renal function as people age?

A

GFR decreases

Renal blood flow decrease

Renal mass decreases

Tubular secretion

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10
Q

How many areas of PK does aging effect?

A

ALL OF THEM!

ADME

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11
Q

How is active transport effected as people age?

A

Part of Absorption

It gets reduced

Things like Vit B12, Iron, Calcium

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12
Q

How is transdermal absorption effected for elderly?

A

Changes int eh skin DECREASE absorption

You get reduced tissue blood perfusion and its not as well hydrated

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13
Q

How is IM absorption for people as they age?

A

It becomes reduced and erratic

They lose muscle mass and its not as well vascularized and should be avoided in elderly if possible

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14
Q

How is the distribution of hydrophilic medications in older patients?

A

They have a decreased Vd, since they have more fat it means the drug will stay in the plasma and and cause an increase in dose

EX of drugs:
Gentamicin

Digoxin

Ethanol

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15
Q

What happens with the distribution of lipophilic medications in geriatric patients?

A

They have an increased Vd, since they have more fat it will deposit itself in there

That means you have a prolonged duration of drug effect

Ex of drugs:

Propofol

Diazepam

Chlordiazepoxide

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16
Q

How are phase I and phase II metabolism effected as we age?

A

Phase I metabolism (cytochrome P450 oxidative) decreases which means it increases T1/2 and will increase drug concentrations

Phase II metabolism (conjugation) is largely unaffected

17
Q

How is the metabolism of pro-drugs effected in geriatric patients?

A

They will have a decrease in first pass activation

This means slowed of decreased activation and lower plasma concentrations of the drug

18
Q

How is excretion effected in geriatric patients in terms of renal function and GFR?

A

They have a decrease in renal function (nephron atrophy and hypoplasia)

They have a decrease in GFR (reduced renal blood flow and decreased filtration)

**this is important because most drugs and/or metabolites are eliminated really

19
Q

What is a problem with geriatric patients and their CrCl and what is done to try and fix this?

A

Since older people have muscle atrophy they hav less creatinine produced

This leads us to have to compensate for muscle mass by if Scr is less than 0.8 or 1 we will round it up to earthier 0.8 or 1 mg/dL

This can be an issue because compensation can lead to UNDERESTIMATING true clearance and thus UNDERDOSING medications

20
Q

What happens with the kinetic parameter with absorption and the parts associated with it as well as the clinical significance of it?

A

Absorption : Unchanged

Gastric pH : increases

Secretory capacity : Decreased

GI blood flow : diminished

Clinical significance is little to none

21
Q

What happens with the kinetic parameter with distribution and the parts associated with it as well as the clinical significance of it?

A

Distribution : diminished

Plasma albumin : diminished

Protein affinity : decreased

Clinical significance : Moderate

22
Q

What happens with the kinetic parameter with metabolism and the parts associated with it as well as the clinical significance of it?

A

Size of liver : decreased

Hepatic blood flow : decreased

Clinical significance : minor

23
Q

What happens with the kinetic parameter with renal function and the parts associated with it as well as the clinical significance of it?

A

GFR : decreased

Renal plasma flow : decreased

Clinical significance : major

24
Q

What are the pharmacodynamic changes that happen to geriatric patients?

A

Aging may result in altered drug response (drug sensitivity)

25
Q

What are the 4 mechanisms that can use pharmacodynamic alterations?

A
  1. Changes in receptor numbers
  2. Changes in receptor affinity
  3. Post-receptor alterations in response (what happens when it binds)
  4. Attenuation of homeostatic mechanics

***depending on the med you can have an increase or decrease in sensitivity

26
Q

What are the most common medications that will lead to hospitalization of geriatric patients?

A

Insulin : 44%

Warfarin : 33%

Antiplatlet : 13%

Oral hypoglycemic agents : 11%

27
Q

What are the Beer’s Criteria?

A

It’s a reference for clinicians about the Risk of PIMS (potentially inappropriate medication) used in older adults

**goal is to reduce unnecessary exposure to PIMS

28
Q

What are some drugs to know that are on AGS Beer’s criteria?

A

Anticholinerics ( 1st gen antihistamine)

Antipsychotics

Meperidine

Benzodiazepines

Estrogens

Sulfonylureas

Insulin

NSAIDS

Muscle Relaxants

Digoxin

29
Q

What s the STOPP/Start criteria

A

It’s a screening tool for older people for prescriptions (STOPP) and a screen tool to alert to right treatment (START)

**alternative to Beers

30
Q

What is OBRA90?

A

It required that a pharmacist review medications on a monthly basis for patients in a long-term care facility

**good because it evaluates if a pt actually needs the meds that they are on and looks for ways to optimize the treatment of the pt

31
Q

What is the FDA Modernization Act of 1997?

A

FDA added geriatric use section to special population section of drug labeling/package inserts

** in the hand outs given to a pt they now they need include information pertaining to geriatric specific considerations

Block: 1.15 (9 decks)

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