Elderly Flashcards
difference between pharmacokinetics & pharmacodynamics
pharmacokinetics: absorption, distribution, metabolism, elimination
pharmacodynamic: how the drug affects the body
Age-related changes
less body weight as water less lean muscle mass more fat less serum albumin lower kidney weight lower hepatic blood flow
high protein bound meds
Warfarin
phenytoin (Dilantin)
Valproic acid (Depakote)
Diazepam (Valium)
meds to avoid in elderly
sleep aids; reduce caffeine
anticholinergics
QT prolongation: Citalopram (use low dose 20 mg) must discontinue if QTc >500 ms
sertraline CYP450 inhibitor/drug interactions
aspirin - gi bleed >80
systemic anticholinergic examples
1st gen antihistamines
Oxybutynin (Ditropan) for OAB avoid IR; use SR
Tricyclic antidepressants (amiytriptyline)
Paroxetine, fluoxetine
antibiotics that could cause torsades de pointes esp in women
macrolides: erythromycin or clarithromycin
alternative to antimicrobial for recurrent UTI in older women
low-dose intravaginal estrogen is safe in breast cancer
A1C goal for frail with limited life expentancy
≤8%
example of age-related change in vascular, pulmonary, cardiac tissue and how it influences pharmacodynamics
decrease in effect of beta-adrenergic agents
beta2-agonists (albuterol, salmeterol)
beta agonists (metoprolol, carvedilol)
when beta2-agonists (albuterol, salmeterol) need additional therapeutic choices
add inhaled muscarinic antagonist/anticholinergics:
- tiotropium (spireva)
- ipatropium bromide (atrovent)
when beta antagonists (metoprolol, carvedilol) need additional therapeutic choices
add calcium channel blocker
- dihydropyridine (amlodipine)
- avoid non-DHP (diltiazem) for risk of PR prolongation
when to avoid high-intensity statin therapy
age ≥80 y impaired renal function frailty multiple comorbidities taking fibrate
alternative to long-term PPI use in elderly
use every other day the H2RA (famotidine or ranitidine BID) and antacid for symptoms avoid trigger foods
consequences of long-term PPI use in elderly
- decreased absorption of iron + Vitamin B needing acidic stomach environment
- fracture risk esp in postmenopausal women
- hypomagnesemia with thiazide, loop diuretics, digoxin
Beers Criteria for PPIs
avoid scheduled use for >8 weeks unless failed H2RA use and for high-risk: oral corticosteroid and chronic NSAID use, erosive esophagitis, Barrett’s esophagitis, pathological hypersecretory condition
