Exam #2: Geriatric Pharmacotherapy

Question 1

What is the BEERS list?

Answer 1

List of drugs that should NOT be used in the geriatric population

Question 2

How do you want to dose medications in geriatric patients?

Answer 2

Start low and then slowly work up

Question 3

How does bioavaliablity of drugs change in the geriatric population?

Answer 3

• Bioavaliablity is NOT changed

- Peak serum concentrations may be lower & slower

Question 4

What is the big exception to drug bioavaliablity in the elderly?

Answer 4

Drugs with extensive first-pass metabolism may have HIGHER serum concentrations due to decreased liver function w/ age

Question 5

What are the factors that affect drug absorption?

Answer 5

• Route
• What its taken w/
• Comorbid illnesses

**Grapefruit juice

Question 6

How can gastric pH alter absorption of durgs?

Answer 6

Increased gastric pH may increase or decrease absorption of some drugs

E.g. proton pump inhibitors will RAISE gastric pH

Question 7

How is metabolic clearance altered in the elderly? Why?

Answer 7

Metabolic clearance is reduce b/c:
- decreased liver blood flow, size, and mass

*****Liver is the most common site of drug metabolism

Question 8

What questions should you be asking your elderly patients in regards to metabolic clearance?

Answer 8

1) Any liver problems

2) Alcohol use

Question 9

Aside from liver issues, what are other factors that affect drug metabolism?

Answer 9

• Age & gender
• Hepatic congestion from CHF
• Smoking

*****Note that blood-thinning medications are most associated with CHF

Question 10

What is the most common arrhythmia in the elderly?

Answer 10

A-fib

Question 11

Why is a-fib common in the elderly?

Answer 11

Uncontrolled HTN leads to remodeling of the heart & predisposition to a-fib

Question 12

What is the definition of half-life?

Answer 12

Time to get to 1/2 the serum concentration of a drug

Question 13

What is clearance?

Answer 13

Volume of serum from which the drug is removed per unit time

Question 14

What is a common initial presentation of anaphylaxis in the elderly?

Answer 14

Nausea & vomiting

Question 15

Where do most drugs exit the body?

Answer 15

Kidney

Question 16

What does reduced drug elimination by the kidneys result in?

Answer 16

Drug accumulation & toxicity

Question 17

What is the overall result of aging on the kidneys? What are the specific effects of aging on the kidneys?

Answer 17

Decreased GFR

• Decreased size
• Decreased RBF
• Decreased number of functioning nephrons
• Decreased renal tubular secretion

Question 18

Why does creatinine stay in the normal range in the elderly, even though there is decreased creatinine clearnace?

Answer 18

Decreased lean body mass= lower creatinine production

BUT

Decreased GFR= compensation & roughly normal creatinine levels

Question 19

What is the problem with benzodiazepines in geriatrics?

Answer 19

More sedation & poorer psychomotr performance

Question 20

When you get to a new hospital or region, what should you find out about drugs?

Answer 20

What meds are prescribed in that region for common conditions

Question 21

What medications are most commonly associated with ADEs?

Answer 21

• Cardiovascular
• Diuretics
• NSAIDs
• Hypoglycemics
• Anticoagulants

**NSAIDs potentially the worst

Question 22

What food can exacerbate CHF?

Answer 22

BBQ (high salt)

Question 23

What has been the most effective way to prevent renal failure associated with DM?

Answer 23

ACE inhibitors

Question 24

What is the most common side effect of an ACE inhibitor?

Answer 24

Cough

Question 25

What are beta-blockers best used for in the geriatric population?

Answer 25

Post MI or CHF

Question 26

Before adding a drug, what must you consider?

Answer 26

Am I prescribing a drug to treat a new symptom or to treat a side effect of a previously prescribed drug?

Question 27

What is the most common side effect of a drug?

Answer 27

GI disruption