elderly Flashcards
Does the amount of med absorbed inc or dec in the elderly?
STAYS THE SAME
Describe how the peak concentration changes as you age? what is an exception to this?
lower and delayed
exception: drugs with first pass - bioavailability may inc
Tell me 5 things that decrease as you age
- liver mass / activity
- GFR
- total body water
- muscle mass
- gastric acidity
What increases as you age?
fat content
are phase I or phase II pathways preferred for breakdown of drugs in the elderly?
phase II
Name some examples of phase II drugs
metoprolol
Name some drugs that are protein bound
warfarin, barbituates, phenytoin, carbamezapine
What drugs are their absorption affected by divalent cations
fluoroquinolones and tetracyclines
Name some drugs that require dose reduction with dec GFR
aminoglycosides, fluoroquinolones, penicillins procainamide, digoxin metformin, lithium bisphosphonates, clofibrates thiazides, atenolol, fluconazole, ACEIs
ozaepam is metabolized faster in men or women?
men
nefazodone is metabolized faster in men or women
women
smoking increases clearance of
theophylline
Name some drugs that utilize hepatic metabolism
NSAIDs, aspirin, acetaminophen calcium blockers, statins, beta blockers tricyclics, SRIs cimetidine, ranitidine, proton pump inhibitors valproic acid , phenytoin erythromycin lidocaine
What type of drug should you avoid since it blocks prostaglandins and dec renal clearance
NSAIDs
Why is creatinine not a reliable measurement of GFR in the elderly? what should you use instead
production dec as you age
use cockroft and gault equation
Which drugs have the highest potential for ADEs
anticholinergics - degenerate the brain
amitryptiline chlorpromadide pysopyramide digoxin GI antispasmodics Merperidine methyldopa Ticlopidine
What are some risk factors for ADEs
6 or more concurrent chronic conditions 12 or more doses/ day 9 or more meds prior adverse drug reactions LBW or BMI age 85 or older CrCl <50
What can an ACE + diuretic cause
hypotension and hypokalemia
what can ACE + potassium cause
hyperkalemia
What can an antiarrythmic + diuretic cause
electrolyte imbalance and arrythmia
What can a benzo + antidepressant cause
confusion and sedation, falls
What can a ca blocker and diuretic cause
hypotension
Whats the risk with megestrol, given in alzheimers patients to increase appetite
thrombotic events
Why should insulin sliding scales and oral hypoglycemics be avoided?
risk of hypoglycemia
What are the s/e of anticholinergics
dry as bone, blind as a bat, hot as a hare, red as a beet, mad as a hatter
confusion, orthostatic hypotension, urinary hesitancy, dry eyes, pupil dilation, constipation
Hepatic congestion from heart failure reduces absorption of what drug
warfarin
What are the most common drug - drug interaction classes
cardiovascular and anti-psych
Metclopramide should be avoided unless for gastoparesis, why?
risk of TD and EPS
Why should NSAIDs be avoided?
GI bleeding
Why should nitrofurantoin be avoided?
pulmonary toxicity
Why should anti-psychs be avoided?
risk of CVA
