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Drug Use In The Elderly Flashcards

1
Q

Elderly patients are:

A

> 65 years old

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2
Q

What are some physiological functions that decrease with age?

A

1) Maximal breathing capacity
2) Cardiac index
3) Glomerular filtration

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3
Q

When the volume of distribution increases, the plasma concentration ___(increases/decreases).

A

Decreases

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4
Q

The volume distribution of lipid soluble drugs will ___(increase/decrease) in the elderly. Why?

A

Increase, due to higher body fat

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5
Q

Clinical manifestations of normal aging include:

A

1) Changes in biochemical makeup of tissues
2) Reduced functional capacity of body systems
3) Reduced ability to adapt to physiological stress
4) Increased vulnerability to disease
5) Frailty (weakness, fatigue, weight loss and functional decline)

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6
Q

What are some examples of impaired homeostatic functions in the elderly?

A

1) Postural or gait instability
2) Orthostatic blood pressure responses
3) Thermoregulation impairment
4) Reduction of cognitive reserve
5) Bowel or bladder dysfunction

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7
Q

The bioavailability of drugs absorbed ___(actively/passively) may not be significantly affected.

A

Passively

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8
Q

The bioavailability of drugs absorbed ___(actively/passively) may have impaired absorption.

A

Actively

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9
Q

Which drugs are absorbed actively?

A

1) Iron
2) B12
3) Magnesium
4) Calcium

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10
Q

In the elderly, the first pass effect is:

A

Decreased

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11
Q

A decrease in the first pass effect results in a(n) ___(increase/decrease) of the bioavailability of some drugs.

A

Increase

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12
Q

A decrease in the first pass effect results in an ___(increase/decrease) of the plasma concentration of some drugs.

A

Increase

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13
Q

A decrease in the first pass effect results in an ___(increase/decrease) of the bioavailability of some pro-drugs.

A

Decrease

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14
Q

Which drugs are affected by a decrease of the first pass effect?

A

1) Propranolol
2) Labetelol

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15
Q

Which pro-drugs are affected by a decrease of the first pass effect?

A

1) Enalapril
2) Codeine

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16
Q

Which drugs need an acidic environment in order to be absorbed?

A

1) Iron
2) Digoxin
3) Conazoles

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17
Q

What might reduce the acidic pH of the stomach in the elderly?

A

1) Atrophic gastritis
2) Gastric acid lowering drugs

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18
Q

What are the factors that influence drug distribution in the elderly?

A

1) Altered plasma protein concentrations

2) Individual body composition (body fat and intracellular fluid content)

3) Decreased muscle and tissue mass

4) Reduced blood flow to tissues and organs

5) Active uptake into tissues

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19
Q

What are some examples of water soluble drugs?

A

1) Ethanol
2) Gentamycin

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20
Q

What are some examples of lipophilic drugs?

A

1) Metronidazole
2) Benzodiazepines
3) Rifampin

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21
Q

Changes in the volume of distribution affect ____ of drugs.

A

Loading doses

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22
Q

The brain of elderly patients may be exposed to ___(lower/higher) concentrations of drugs and toxins. Why?

A

Higher; Because of age-related changes in the blood-brain-barrier.

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23
Q

Hepatic metabolism of drugs depends on:

A

1) Liver perfusion
2) Activity and capacity of drug metabolizing enzymes
3) Protein binding

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24
Q

Drugs that have a high intrinsic clearance have:

A

High hepatic extraction ratios

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25
Hepatic clearance depends on:
Hepatic blood flow (flow-limited metabolism).
26
If hepatic blood flow decreases, the metabolism of high extraction ratio drugs ___(increases/decreases).
Decreases
27
What are some high extraction ratio drugs?
1) Propranolol 2) Amitriptyline 3) Diltiazem 4) Lidocaine 5) Metoprolol 6) Morphine 7) Verapamil
28
Serum ___ is a poor indicator of renal function in the elderly. Why?
Creatinine; Creatinine is produced by muscles and there is reduced muscle mass in the elderly.
29
Which equation may be used to calculate creatinine clearance?
Cockcroft and Gault
30
What should you multiply the Cockcroft and Gault equation with for females?
0.85
31
Accurate measurement of _____ is required for dose adjustment in patients with reduced renal function.
Creatinine clearance
32
Dosing guidelines of drugs that are eliminated by the kidney are based on ____.
Creatinine clearance
33
Which drugs should be avoided when Creatinine Clearance (CLcr) < 30 mL/min?
1) Colchicine 2) Co-trimoxazole 3) Glyburide 4) Nitrofurantoin 5) Probenecid 6) Spironolactone 7) Triamterene
34
Which drugs need dose reduction in reduced renal function?
1) Acyclovir 2) Amantadine 3) Ciprofloxacin 4) Gabapentin 5) Ranitidine
35
Changes leading to altered pharmacodynamics of drugs may include:
1) Changes in drug concentration at the receptor 2) Changes in receptor numbers 3) Changes in receptor affinity 4) Post-receptor changes 5) Age-related changes in homeostatic mechanisms
36
Why are older adults more sensitive to the CNS effects of drugs?
1) Changes in size and weight of brain 2) Changes in the neurotransmitter systems 3) Drugs penetrate CNS easier than in young adults
37
Why do the elderly show increased sensitivity to the adverse effects of antipsychotic drugs?
1) Decreased levels of dopamine transporters 2) Decreased number of dopaminergic neurons 3) Decreased density of dopamine receptors
38
Which drugs show increased sensitivity in the elderly?
1) Benzodiazepines 2) Opioids 3) General anesthetics 4) Antipsychotics 5) Lithium 6) Anticholinergics
39
The elderly are more likely to develop ___ as an adverse effect of some antihypertensive drugs.
Orthostatic hypotension
40
The elderly are more likely to develop ___ as an adverse effect of some calcium channel blockers.
Increased hypotensive and bradycardic effect
41
The elderly are more likely to develop ___ as an adverse effect of some β-blockers.
Reduced blood pressure response
42
The elderly are more likely to develop ___ as an adverse effect of some diuretics.
Reduced effectiveness
43
The elderly are more likely to develop ___ as an adverse effect of Warfarin.
Increased risk of bleeding
44
State 3 important, potentially preventable, negative outcomes of drugs in the elderly.
1) Withdrawal effects 2) Therapeutic failure 3) Adverse drug reactions
45
What are the risk factors of drug-related problems in the elderly?
1) Polypharmacy 2) Inappropriate Prescribing 3) Underuse 4) Medication non-adherence
46
Polypharmacy has been strongly associated with:
1) Adverse drug reactions 2) Risk of geriatric syndromes (falls, cognitive impairment) 3) Non-adherence 4) Diminished functional status 5) Increased health care costs
47
Polypharmacy includes:
1) Prescription drugs 2) Nonprescription drugs 3) Herbal medicines 4) Supplements 5) Unnecessary drugs
48
Inappropriate prescribing includes:
1) Wrong dose and duration 2) Duplication 3) Drug interaction problem 4) Prescription of drugs that should be avoided in the elderly
49
What is underuse?
Removal/omission of drug therapy that is indicated in prevention or treatment of disease.
50
Causes of medication non-adherence?
1) Adverse effects 2) Complex regimens 3) Misunderstanding of information about prescribed medications 4) Cost 5) Dysmobility (arthritis, etc.) 6) Social factors (living alone) 7) Dementia
51
A drug may be considered unnecessary if:
1) It does NOT have indication per the problem list. 2) Is NOT effective. 3) The risk outweighs the benefits. 4) There is therapeutic duplication.
52
How do you assess and monitor drug therapy in the elderly?
1) Compare the patient’s problem list with drug list. 2) Determine if the patient has a chronic condition but is NOT receiving an evidence based medication to improve outcome. 3) Monitor effectiveness and toxicity of drugs by clinical assessment and lab tests. 4) Documenting problems and formulating a therapeutic Plan 5) Implement a team-based management approach and develop strategies to avoid prescribing errors. 6) Take measures to enhance adherence to medications 7) Assess the presence of drug-disease interaction
53
What lab test should be done with Amiodarone?
Hepatic function tests
54
What lab test should be done with Antiepileptics?
Drug level
55
What lab test should be done with ACEi & ARBs?
Serum K+ level
56
What should we look for when using antipsychotics?
Extrapyramidal adverse drug reactions
57
What lab test should be done with diuretics?
Serum K+ level
58
What lab test should be done for hypoglycemics?
1) Glucose 2) Glycated Hb
59
What lab test should be done with Lithium?
Drug level
60
What lab test should be done with Warfarin?
PT or INR
61
What should you take into account when documenting problems and formulating a therapeutic plan for the elderly?
1) Remaining life expectancy 2) Time until therapeutic benefit 3) Treatment target 4) Medication regimen complexity 5) Goals of care
62
What measures could you take to enhance adherence to medications?
1) Modify medication schedule to fit patient’s lifestyle 2) Prescribe generic agents to reduce cost 3) Offer easy-to-open bottles 4) Offer easy-to-swallow dosage forms 5) Provide both written and oral drug information 6) Involve caregivers stressing the importance of adherence
63
What are some side effects or diseases caused by anticholinergics?
1) Benign prostatic hyperplasia 2) Dementia or cognitive impairment
64
What are some side effects or diseases caused by antipsychotics?
1) History of falls 2) Parkinson’s disease
65
What are some side effects or diseases caused by aspirin?
Peptic ulcer disease
66
What are some side effects or diseases caused by Calcium channel blockers?
Heart failure
67
What are some side effects or diseases caused by Metoclopramide?
Parkinson’s disease
68
What are some side effects or diseases caused by NSAIDs?
1) Peptic ulcer disease 2) Heart failure 3) Renal failure
69
Why shouldn't you give Anticholinergics with other drugs with anticholinergic activity such as antihistamines?
Elimination reduced in older adults
70
What are the risks of using Anticholinergics with other drugs with anticholinergic activity such as antihistamines?
1) Confusion 2) Dry mouth 3) Constipation 4) Urine retention
71
Which drugs are potentially inappropriate for elderly?
1) Anticholinergics + H1 blockers 2) Nitrofurantoin 3) Peripheral and central α-blockers 4) Immediate-release nifedipine 5) Amiodarone 6) Antidepressants 7) Antipsychotics 8) Barbiturates & benzodiazepines 9) Long-acting sulfonylureas 10) Metoclopramide 11) Proton pump inhibitors 12) Meperidine (Pethidine) 13) NSAIDs 14) Central muscle relaxants
72
Why shouldn't you give Nitrofurantoin to the elderly?
1) Pulmonary toxicity 2) Hepatotoxicity 3) Peripheral neuropathy
73
Why shouldn't you give peripheral and central α-blockers to the elderly?
1) High risk of adverse effects 2) Orthostatic hypotension 3) CNS adverse effects
74
Why shouldn't you give immediate-release nifedipine to the elderly?
1) Hypotension 2) Myocardial ischemia
75
Why shouldn't you give Amiodarone to the elderly?
High risk of many adverse effects
76
Why shouldn't you give antidepressants to the elderly?
1) Highly anticholinergic 2) Sedating 3) Orthostatic hypotension 4) Myocardial ischemia
77
Why shouldn't you give antipsychotics to the elderly?
1) Increased risk of CVA 2) Cognitive decline 3) Dementia 4) Mortality
78
Why shouldn't you give barbiturates & benzodiazepines to the elderly?
1) High rate of dependence 2) Tolerance 3) Sedation 4) Cognitive impairment 5) Delirium 6) Falls 7) Fractures
79
What is the insulin sliding scale?
The progressive increase in the pre-meal or nighttime insulin dose, based on pre-defined blood glucose ranges
80
Why shouldn't you use the insulin sliding scale in the elderly?
Increased risk of hypoglycemia
81
Why shouldn't you use the long-acting sulfonylureas in the elderly?
Increased risk of hypoglycemia
82
Why shouldn't you use Metoclopramide in the elderly?
Increased risk of extrapyramidal adverse effects, dyskinesia
83
Why shouldn't you use the proton pump inhibitors in the elderly?
Risk of Clostridium difficile infection
84
Why shouldn't you use Meperidine (pethidine) in the elderly?
High risk of neurotoxicity, including delirium
85
Why shouldn't you use the NSAIDS in the elderly?
1) Peptic ulcer disease 2) Cardiovascular disease 3) Renal failure
86
What are some central muscle relaxants?
1) Chlorzoxazone 2) Cyclobenzaprine 3) Orphenadrine
87
Why shouldn't you use central muscle relaxants in the elderly?
1) Poorly tolerated because of anticholinergic effects 2) Sedation 3) Increased risk of falls and fractures

Therapeutics (23 decks)

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