Drug Use In The Elderly Flashcards
Elderly patients are:
> 65 years old
What are some physiological functions that decrease with age?
1) Maximal breathing capacity
2) Cardiac index
3) Glomerular filtration
When the volume of distribution increases, the plasma concentration ___(increases/decreases).
Decreases
The volume distribution of lipid soluble drugs will ___(increase/decrease) in the elderly. Why?
Increase, due to higher body fat
Clinical manifestations of normal aging include:
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)
What are some examples of impaired homeostatic functions in the elderly?
1) Postural or gait instability
2) Orthostatic blood pressure responses
3) Thermoregulation impairment
4) Reduction of cognitive reserve
5) Bowel or bladder dysfunction
The bioavailability of drugs absorbed ___(actively/passively) may not be significantly affected.
Passively
The bioavailability of drugs absorbed ___(actively/passively) may have impaired absorption.
Actively
Which drugs are absorbed actively?
1) Iron
2) B12
3) Magnesium
4) Calcium
In the elderly, the first pass effect is:
Decreased
A decrease in the first pass effect results in a(n) ___(increase/decrease) of the bioavailability of some drugs.
Increase
A decrease in the first pass effect results in an ___(increase/decrease) of the plasma concentration of some drugs.
Increase
A decrease in the first pass effect results in an ___(increase/decrease) of the bioavailability of some pro-drugs.
Decrease
Which drugs are affected by a decrease of the first pass effect?
1) Propranolol
2) Labetelol
Which pro-drugs are affected by a decrease of the first pass effect?
1) Enalapril
2) Codeine
Which drugs need an acidic environment in order to be absorbed?
1) Iron
2) Digoxin
3) Conazoles
What might reduce the acidic pH of the stomach in the elderly?
1) Atrophic gastritis
2) Gastric acid lowering drugs
What are the factors that influence drug distribution in the elderly?
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
What are some examples of water soluble drugs?
1) Ethanol
2) Gentamycin
What are some examples of lipophilic drugs?
1) Metronidazole
2) Benzodiazepines
3) Rifampin
Changes in the volume of distribution affect ____ of drugs.
Loading doses
The brain of elderly patients may be exposed to ___(lower/higher) concentrations of drugs and toxins. Why?
Higher; Because of age-related changes in the blood-brain-barrier.
Hepatic metabolism of drugs depends on:
1) Liver perfusion
2) Activity and capacity of drug metabolizing enzymes
3) Protein binding
Drugs that have a high intrinsic clearance have:
High hepatic extraction ratios
Hepatic clearance depends on:
Hepatic blood flow (flow-limited metabolism).
If hepatic blood flow decreases, the metabolism of high extraction ratio drugs ___(increases/decreases).
Decreases
What are some high extraction ratio drugs?
1) Propranolol
2) Amitriptyline
3) Diltiazem
4) Lidocaine
5) Metoprolol
6) Morphine
7) Verapamil
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.
Which equation may be used to calculate creatinine clearance?
Cockcroft and Gault
What should you multiply the Cockcroft and Gault equation with for females?
0.85
Accurate measurement of _____ is required for dose adjustment in patients with reduced renal function.
Creatinine clearance
Dosing guidelines of drugs that are eliminated by the kidney are based on ____.
Creatinine clearance
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
Which drugs need dose reduction in reduced renal function?
1) Acyclovir
2) Amantadine
3) Ciprofloxacin
4) Gabapentin
5) Ranitidine