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Life cycles > Exam 3- principles of old age pharm > Flashcards

Exam 3- principles of old age pharm Flashcards

1
Q

when does pediatric absorption equal adults?

A

1 year= similar

2 year= acid production is equal to adults

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2
Q

does loading dose change with age?

A

not really

Cp [mg/L]= DOSE (mg)/Vd (L)

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3
Q

pediatric hepatic metabolism

A
  • function of postnatal age aka very variable compared to adults
  • hard to predict
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4
Q

grey baby syndrome

A
  • example of developing hepatic metabolism

- caused by poor clearance of chlorampenicol (delayed development of glucoronidation)

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5
Q

CYP1A2 (phase I)

A

reach adult llevels are 4-5 mo

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6
Q

cyp2c9(phase I)

A

> adult levels until teens (<30% at birth)

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7
Q

CYP2D6 (phase I)

A

reach adult levels by 10 yo

NO activity at birth

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8
Q

CYP3A4 (phase I)

A

greater than adult levels by 1 year (30%- 75% at birth)

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9
Q

phase II pathyways in the young ones

A
  • sulfate/ glycine conjugation= adult levels at birth
  • acetylation= adult levels by 2 years
  • glucuronide conjugation= 0-25% at birth –> adult levels by 2-3 years
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10
Q

is renal or hepatic clearance more predictable in kids?

A

renal

-generally renally cleared drugs are cleared faster in kids than adults

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11
Q

what pharmacokinetic consideration changes a lot with age?

A

maintenance dose

usu higher in kids than adults

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12
Q

what antibiotic should not be giving to kinds under 9 due to permanent tissue staining? Why?

A

tetracycline stains teeth.

incorporates into calcifying bone, cartilage, teeth. It is not permanent in tissues that remodel (bone/ cartilage)

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13
Q

things you shouldn’t give to kids due to life threatening reactions

A 
benzonatate
iron
TCA
antipsychotics
antimalarials
antiarrythmic
CCB
sulonylureas
opiods
acetaminophen
diphenhydramine
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14
Q

epi of aging and pharm

A
  • 14% over 65
  • 20-25% over 65 by 2030
  • use 30-40% of prescription drugs
  • on multiple chronic meds
  • 40% over age 60 take at least 5 meds
  • **25% of ED visits/ 40% of hospital stays due to adverse drug events
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15
Q

GI changes in elderly and how it effects meds

A
  • decreased gastric acid (increase pH)
  • -decrease weak acid drugs: warfarin, penicillin
    • increase weak base drugs: TCA, benzo, opiods, anticonvulsants
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16
Q

take home about absorption in the elderly

A

RATE is changed with age, but BIOAVAILABILITY doesn’t change much

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17
Q

how does body comp change with aging? how does that change Vd of water soluble/ lipid soluble drugs?

A
  • DECREASE total body water + lean body mass
  • –decrease Vd for water soluble drugs –> higher Cp @ nl dose
  • INCREASE adipose tissue
  • –increase Vd of lipid soluble drugs –> prolonged elimination, drug accumulation

**fat is the only thing that INCREASES, all other tissues decrease in size, production, fx whatever

18
Q

how does hepatic metabolism change with age? is phase I or phase II affected more?

A
  • decrease mass/ blood flow after age 40
  • phase I affected more, decrease 30ish%
  • phase II more reliable
  • NO GOOD MARKER–> titration necessary

Phase II: Geriatrics have More Gas (methylation, glucoronidation, acetylation, sulfation)

19
Q

Age is part of the CrCl equation. Yes it is. What are drugs that accumulate with renal impairment?

A 
dig
aminoglycosides
H2 bockers
allopurinol
penicillins
cephs
amantadine
lithium
metoclopramide
20
Q

BEERS LIST

A

use to determine medication use in patients > 65

-but its poorly organized, DDI not addressed, doesn’t consider exceptions (palliation),

21
Q

STOPP and START screening tools

A

Screening Tool of Older Person’s potentially inappropriate Prescription

Screening Tool to Alert doctors to Right Treatment

22
Q

Whats the points of STOPP START screening tools

A
  • red flag areas of POTENTIAL intervention
  • STOPP: identifies clinical concerns within a drug class, suggests therapuetic alternatives
  • START: suggests appropriate drug use, build from monotherapy
23
Q

pediatric drug reactions: GCs, CNS stimulants, tets, salicylates

A

GC –> growth inhibitors via pit GH suppression
Stimulants (ADHD: methylpenidate, dextroampethamine) –> may have growth stunting effect, probably due to app suppresion
Tets –> stain yo teeth
Salicylates (ASA esp) –> risk hepatic dysfx, Reyes

24
Q

mobility: drugs that effect supporting structures

A

corticosteroids
phenytoin
heparin
dec vit d

ALL make arthralgis, myopathies, osteoporosis WORSE

25
Q

mobility: drugs that make movemebt d/os worse

A

antipsychotics –> EPS

metaclopramide –> blocks D2

26
Q

mobility: drugs that make elements of balance WORSE

A
  • tinnitus/ vertigo: asa, aminoglyc, ethacrynic acid
  • hypoTN: BB, CCB, diuretics, vasdilators, antidepressants
    psychomotor: benzos, antihistamines, antipsychotics, anti-D
27
Q

drugs that increase fall risk

A

benzos –> chose Z drugs for insomnia

TCA, meperidine-methadone

28
Q

how do you treat urinary retention in old people? what are some drugs tha tmake it worse

A
  • tamsulosin (a-adrenergic ant)

- anticholinergics + drugs with anticholinergic side effects

29
Q

drugs that make stress incontinence worse in old people

A

alpha adrenergic antagonists (prazosin, doxazosin)

30
Q

Why does urge incontinence happen? what drugs make it worse? what makes it better?

A

detrusor hyperreflexia with sphincter dysfunction

-cholinerigics, diuretics

tx with antimuscarinics

31
Q

constipation worsened by?

A

opiods, antimuscs, 1 gen antihistamines, CCBs (verapamil esp)

32
Q

life expectancy

life span

A

men: 77
women: 82

lifespan= maximal life expectancy –>humans: about 110

33
Q

how does brain volume decrease?

A

loss of MYELIN

maybe ssome subcortical nuclie in gray matter

34
Q

how do lungs age?

A

decrease elastic tissue, emphysematous change

35
Q

normal aging of kidney, heart, liver

A

kidney: loss of nephron

liver/heart : accumulation of lipofuscin (“wear and tear” pigment, comes from peroxidation of unsaturated fatty acids)

36
Q

atherosclerosis affects which vessels?

A

major arteries, starts in the intima

37
Q

is DMII associated with aging?

A
  • diabetics age an increased rate
  • dec life expectancy by 10 years
  • build of of NEG in vessels, thickening BM, retinopathy, etc
38
Q

clock theory of aging (debunked)

A

genetically programmed

  • correlation to limit of duplication to lifespan seen in difference cell types in vitro
  • TTAGGG= tandem repeats in telomeres –> decreases over lifespan by 50bp
39
Q

rust theory of aging

A

oxidative effect on tissues
-decreased capacity to do oxidative phosphorylation in mitocondrial DNA

-caloric restriction increases lifespan in animals?

40
Q

telomerase erosion diseases

A
  • hyperpigmentation
  • oral leukoplakia
  • BM failure
  • thickening of nails
  • progeria –> mutation in lamin A
  • werners –> mut in helicase

Life cycles (16 decks)

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