Exam 3: Old people pharm

Question 1

Which of the factors change the least with age:
Absorption
Distribution
Metabolism
Elimination

Answer 1

Absorption

Question 2

Propranolol vs. atenolol

Answer 2

Lipiphillia of propranolol leading to increased activity
Higher fat stores in elderly
Therefore increased Vd

Other examples of polar (not lipophilic) drugs - increases:
Gentamycin
Lithium
Digoxin

Question 3

Aging and metabolism

Answer 3

Clearance may be reduced with aging
Phase 1 pathways (ox, red, hydrolysis) most affected
Increased active metabolisms
Hereditary difference may be more important than aging

Question 4

Which factor changes most with age:
Absorption
Distribution
Metabolism
Elimination

Answer 4

Elimination

Question 5

Important estimates/equations of renal clearnance

Answer 5

Estimate with serum creatinine
Less body mass = less creatinine: therefore normal values may be high in small old people
Cockroft-Gault equation

Question 6

Warfarin differences in elderly vs. young

Answer 6

Pharmacodynamic differences (not kinetics)
Greater risk is due to general increased risk for bleeding: fall risk etc

Question 7

Risk factors for adverse drug effects (unintended or undesired effects)

Answer 7

Most common: Inconsistent medication compliance
Other:
6 or more chronic conditions
12 or more doses of drug
9 or more meds
Prior ADE
Low BMI
>85 years old
CrCl <50 mL/min

Question 8

Beers’ top drugs to avoid

Answer 8

TCAs
Diphenhydramine/1st gen antihistamines
Clonidine
Amiodarone
High dose digoxin
All benzos
Glyburide
Indomethacin

Question 9

Most common forgot about drug induced parkinson’s

Answer 9

Metoclopromide
Valproic acid
Prochloroperizine

Question 10

HTN treatments in elderly

Answer 10

HTN may be good over 85?
Adding antiHTN can increase incidence of falls and cognitive decline
Decreasing stroke risk is important but NNT of 100 and additional meds needs to be continues
Gait speed is best indicator (slow speed = leave HTN, fast speed, 2/3 mph = treat HTN)

Question 11

Guidelines in elderly

Answer 11

BPGs often not based on evidence in older pop

Question 12

Tight control of sugar

Answer 12

From uncontrolled, 5-10 years to see effect on microvascular dx of tight control
<7.5% = increased hypoglycemia risk = falls

Question 13

Statin discontinuation

Answer 13

Increased quality of life
Decreased muscle pain
No increased in cardio events

Question 14

Principles for prescribing

Answer 14

DDI
Avoid polypharm
Compliance considerations
OTC meds
AR (way better than RR), NNT good measures
Time to benefit