Exam #2: Geriatric Pharmacotherapy Flashcards
What is the BEERS list?
List of drugs that should NOT be used in the geriatric population
How do you want to dose medications in geriatric patients?
Start low and then slowly work up
How does bioavaliablity of drugs change in the geriatric population?
- Bioavaliablity is NOT changed
- Peak serum concentrations may be lower & slower
What is the big exception to drug bioavaliablity in the elderly?
Drugs with extensive first-pass metabolism may have HIGHER serum concentrations due to decreased liver function w/ age
What are the factors that affect drug absorption?
- Route
- What its taken w/
- Comorbid illnesses
**Grapefruit juice
How can gastric pH alter absorption of durgs?
Increased gastric pH may increase or decrease absorption of some drugs
E.g. proton pump inhibitors will RAISE gastric pH
How is metabolic clearance altered in the elderly? Why?
Metabolic clearance is reduce b/c:
- decreased liver blood flow, size, and mass
*****Liver is the most common site of drug metabolism
What questions should you be asking your elderly patients in regards to metabolic clearance?
1) Any liver problems
2) Alcohol use
Aside from liver issues, what are other factors that affect drug metabolism?
- Age & gender
- Hepatic congestion from CHF
- Smoking
*****Note that blood-thinning medications are most associated with CHF
What is the most common arrhythmia in the elderly?
A-fib
Why is a-fib common in the elderly?
Uncontrolled HTN leads to remodeling of the heart & predisposition to a-fib
What is the definition of half-life?
Time to get to 1/2 the serum concentration of a drug
What is clearance?
Volume of serum from which the drug is removed per unit time
What is a common initial presentation of anaphylaxis in the elderly?
Nausea & vomiting
Where do most drugs exit the body?
Kidney
What does reduced drug elimination by the kidneys result in?
Drug accumulation & toxicity
What is the overall result of aging on the kidneys? What are the specific effects of aging on the kidneys?
Decreased GFR
- Decreased size
- Decreased RBF
- Decreased number of functioning nephrons
- Decreased renal tubular secretion
Why does creatinine stay in the normal range in the elderly, even though there is decreased creatinine clearnace?
Decreased lean body mass= lower creatinine production
BUT
Decreased GFR= compensation & roughly normal creatinine levels
What is the problem with benzodiazepines in geriatrics?
More sedation & poorer psychomotr performance
When you get to a new hospital or region, what should you find out about drugs?
What meds are prescribed in that region for common conditions
What medications are most commonly associated with ADEs?
- Cardiovascular
- Diuretics
- NSAIDs
- Hypoglycemics
- Anticoagulants
**NSAIDs potentially the worst
What food can exacerbate CHF?
BBQ (high salt)
What has been the most effective way to prevent renal failure associated with DM?
ACE inhibitors
What is the most common side effect of an ACE inhibitor?
Cough
What are beta-blockers best used for in the geriatric population?
Post MI or CHF
Before adding a drug, what must you consider?
Am I prescribing a drug to treat a new symptom or to treat a side effect of a previously prescribed drug?
What is the most common side effect of a drug?
GI disruption
