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308 Clinical pharmacology > Drugs in health and disease 2 > Flashcards

Drugs in health and disease 2 Flashcards

1
Q

What is the risk of giving warfarin and ibuprofen?

A

Increased bleeding risk

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2
Q

Why is drug absorption decreased and steady state time increased in the elderly?

A 
Reduced saliva
Reduced gastric acid
Decreased GI motility
Reduced surface area for absorption
Reduced splanchnic blood flow
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3
Q

What is volume of distribution?

A

Hypothetical volume obtained if all drug was in blood

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4
Q

What is the equation of volume of distribution?

A

Vd = (amount of drug in body) / (concentration in plasma)

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5
Q

What does volume of distribution affect?

A

Half life and duration of effect

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6
Q

Why does drug distribution differ in the elderly?

A

Decreased lean body mass
Increased body fat
Decreased body of water
Albumin decreased

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7
Q

What is the consequence of decreased lean body mass?

A

Decreased volume of distribution for drugs that distribute into muscles
Increased plasma concentration

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8
Q

What is the consequence of increased body fat?

A

Increased volume of distribution for fat soluble drugs

Increased half life

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9
Q

What is the consequence of decreased body of water?

A

Decreased volume of distribution of water-soluble drugs
Increased plasma concentration
Loading doses are lower

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10
Q

What further decreases albumin?

A 
Heart failure
Renal disease
Rheumatoid arthritis
Hepatic cirrhosis
Malignancies
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11
Q

What drugs does decreased albumin affect?

A 
Phenytoin
Warfarin
Propanolol
Diazepam
Levothyroxine
Digoxin
Furosemide
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12
Q

What are the cardiac signs of digoxin toxicity?

A

Heart block
Bradycardia
Junctional tachycardia

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13
Q

What are the psychiatric signs of digoxin toxicity?

A 
Delirium
Fatigue
Malaise
Confusion
Dizziness
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14
Q

What are the visual signs of digoxin toxicity?

A

Blurred or yellow-green vision
Halos
Double vision
Photophobia

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15
Q

What are the gastrointestinal signs of digoxin toxicity?

A 
Nausea
Vomiting
Anorexia
Diarrhoea
Abdominal pain
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16
Q

What size effects can benzodiazepine cause?

A

Drowsiness
Confusion
Ataxia

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17
Q

What is used to treat benzodiazepine overdose?

A

IV flumazenil 200mcg

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18
Q

What are the signs of phenytoin toxicity?

A 
Nausea and vomiting
Tremor
Ataxia
Nystagmus
Coarse facies
Hepatitis
19
Q

How do warfarin and aspirin interact?

A

Warfarin is highly bound to plasma albumin
Warfarin has a narrow therapeutic index and small volume of distribution
Aspirin can displace warfarin from plasma albumin increases concentration of warfarin

20
Q

What are the adverse effects of aspirin?

A

Peptic ulcer disease
Bleeding tendency
Fluid retention
Renal failure

21
Q

How does liver metabolism differ in the elderly?

A

Decreased liver volume
Decreased liver blood flow
Decreased first pass metabolism
Decreased enzyme activity CP450

22
Q

What drugs can be affected by CP450?

A 
Antidepressants
Antipsychotics
Beta blockers
Opiates
Benzodiazepines
Calcium channel blockers
Theophylline
Warfarin
Phenytoin
NSAIDs
Paracetamol
Erythromycin
23
Q

How does excretion differ in the elderly?

A

Decreased renal mass
Decreased renal function
Half life increases

24
Q

Give examples of drugs that are primarily excreted by the kidneys?

A 
Digoxin
Atenolol
Sotalol
Lithium
Allopurinol
Many antibiotics
25
Q

What are the implications of reduced excretion for prescribing?

A

Reduce dosage in OD preps

Increase dose interval in more frequently administered drugs

26
Q

What are the signs of early lithium toxicity?

A

Tremor
Agitation
Twitching

27
Q

What are the signs of intermediate lithium toxicity?

A

Lethargy

28
Q

What are the signs of late lithium toxicity?

A

Coma
Fits
Arrhythmias
Renal failure

29
Q

What are the signs of morphine toxicity?

A 
Nausea and vomiting
Constipation
Drowsiness
Respiratory depression
Hypotension
30
Q

How to treat morphine toxicity?

A

Naloxone IV 400mcg

31
Q

Why is there is a progressive decline in homeostatic mechanisms for pharmacodynamics in the elderly?

A

? due to receptor affinity or number
? alterations in 2nd messenger function
? alterations in cellular and nuclear responses

32
Q

Give examples of drugs that have increased effects in the elderly

A 
Alcohol
Benzodiazepines
Warfarin
Hypotensives
GI effects of NSAIDs
Central effects of anticholinergics
33
Q

Give examples of drugs that have decreased effects in the elderly

A

Beta1 modulators in cardiac tissue
Reduced bronchodilators response to beta agonists
CCB effect on PR interval decreased

34
Q

What are the side effects of ACE inhibitors?

A

Hypotension
Hyperkalaemia
Renal failure
Cough

35
Q

What are the side effects of beta blockers?

A 
Hypotension
Confusion
Bradycardia
Lethargy
Impotence
36
Q

What are the side effects of calcium channel blockers?

A

Hypotension
Negatively inotropic
Fluid retention

37
Q

What are the side effects of diuretics?

A 
Hypotension
Hypokalaemia
Hyponatraemia
Confusion
Dehydration
38
Q

What are the side effects of haloperidol?

A 
Confusion
Sedation
Parkinsonism
Tardive dyskinesia
Neuroleptic malignant syndrome
39
Q

Why might compliance be lower in the elderly?

A

Cognitive problems
Manual dexterity
Visual problems
Dysphagia

40
Q

What adverse drug reactions can steroids cause?

A

Osteoporosis
Gastric irritation / ulcers
Hyperglycaemia

41
Q

What adverse drug reactions can tricyclic antidepressants cause?

A 
Cardiac arrhythmias
Drowsiness
Dry mouth
Constipation
Urinary retention
42
Q

What adverse drug reactions can NSAIDs cause?

A

Renal failure
Gastric irritation
Fluid retention

43
Q

What adverse drug reactions can alpha blockers cause?

A

Drowsiness
Hypotension
Syncope
Selective alpha blockers can cause urinary retention

308 Clinical pharmacology (10 decks)

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