Exam 11: Geriatric Pharm

Question 1

GI effects of aging

Answer 1

Reduced cell regeneration and muscle tone
Slower digestion, greater residence time
Greater risk of malabsorption and constipation

Question 2

Liver effects of aging

Answer 2

20-40% size reduction over time
Less blood flow
Lower CYP 450 concentrations
Slower hepatic clearance of drugs

Question 3

Cardiovascular effects of aging

Answer 3

50% decrease in flow to kidneys
20% decrease in flow to the brain
Orthostatic and postprandial hypotension
Resting HR and CO are stable
Stiffening of aorta (increased systolic BP)

Question 4

Brain effects of aging

Answer 4

Shrinks
less blood flow
More permeable BBB
Reduced DA, 5-HT, glutamate, ACh signaling

Question 5

Effects of aging on kidneys

Answer 5

Reduced blood flow (10%/decade)
Reduced GFR (1%/year after 30)
Proteinuria is NOT NORMAL

Question 6

Why isn’t creatinine clearance reliable in the elderly to measure GFR?

Answer 6

Reduced lean body mass results in lower Cr clearance without affecting the actual GFR

Question 7

How does aging affect Vd?

Answer 7

More fat, less water:
Longer half-lives of lipophilic drugs
Increased concentrations of water soluble drugs

Question 8

How does aging affect protein bound drugs in frail, sick patients?

Answer 8

Increased free concentrations because they have less albumin

Question 9

What type of liver metabolism is reduced with age? Unchanged/

Answer 9

Reduced oxidative metabolism

Unchanged conjugative metabolism

Question 10

How is drug elimination at the kidneys effected by age?

Answer 10

Less GFR

Less tubular secretion

Question 11

NSAIDs and aging?

Answer 11

can hurt kidneys

Question 12

Anticholinergics and aging

Answer 12

cognitive impairment
psychosis
tachycardia

Question 13

Benzos and aging

Answer 13

They’re more sensitive to benzos

Cognitive decline and falls

Question 14

ACE inhibitors and aging

Answer 14

Impaired renal clearance leads to longer half life

Hypotension/hyperkalemia

Question 15

Prescribing cascade

Answer 15

phenomenon when you prescribe drugs to treat drug side effects and then have to prescribe other drugs to treat the side effects of those drugs and so on

Question 16

How should you use Beers list and Canadian criteria list (CCL)

Answer 16

they’re just tools for reducing adverse drug events

Dont let them get in the way of giving the patient the best personalized therapy

Question 17

4 medications associated with adverse drug effects in the elderly?

Answer 17

Opioids
NSAIDs
Anticholinergics
Benzos

Question 18

Why do we need to be careful with opioids in the elderly?

Answer 18

Decreased GFR
Reduced liver function
Phase I reaction impairment
Side effects increased

Question 19

Concerns with Benzos in the elderly

Answer 19

more sensitive
more sedation, unsteadiness, memory loss
falls, vehicular accidents
sensitivity may be due to GABAa receptors

Question 20

Dosing benzos in the elderly

Answer 20

cut the dose in half

use drugs with short half-lives

Question 21

2 benzos appropriate for use in patients with decreased liver function

Answer 21

Lorazepam

Oxazepam

Question 22

2 drugs with increased serum levels when taken with benzos

Answer 22

Digoxin and phenytoin

Question 23

grapefruit juice effects on drugs

Answer 23

Can cause either overdose or reduced dose depending on the drug metabolism

Question 24

SAIL mnemonic

Answer 24

Simple (keep the drug regimen simple)
Adverse effects (understand them)
Indication (is there a clear reason for giving the drug)
List (give patients a list of their drugs)