Ger pharm ARS

Question 1

What changes LEAST with age? Most?
Absorption
DIstribution
Metabolism
Elimination

Answer 1

Least: Absorption

• bioavailability does not change
• peak serum [ ] may be lower and delayed

Most: Elimination

Question 2

80 y.o hypertensive woman is switched from atenolol to propanolol to treat tremor.
A week later, she seems more bradycardic, confused, and despondent, why?

Answer 2

Lipophilia of propanolol

• BC old peepo have higher fat stores, they have higher volume of distribution for lipophilic drugs. Lipid soluble drugs are more likely to get into brain.

Question 3

Effects of aging on VD:

lower body water

Answer 3

lower VD for hydrophilic drugs

Question 4

Effects of aging on VD:

Decreased lean body mass

Answer 4

lower VD for drugs that bind to muscle

Question 5

Effects of aging on VD:

Higher fat stores

Answer 5

higher VD for lipophilic drugs and lipid soluble more likely to get into brain

Question 6

Effects of aging on VD:

Decreased plasma protein (albumin)

Answer 6

higher % of drug that is unbound (active)

Question 7

Liver is the most common site of drug metabolism. Why is metabolic clearance of drug by liver reduced in elderly?

Answer 7

Liver blood flow, size, and mass of liver decreases

Question 8

Does serum creatinine reflect creatinine clearance in elderly?

Answer 8

no
they have lower lean body mass –>
lower creatinine production AND less creatinine to clear

*in older persons, serum creatinine may stay in nl range despite decline in creatinine clearance

Question 9

Most common cause of adverse drug rxns in elderly is

Answer 9

number of meds prescribed

Question 10

Risk factors for ADR

Answer 10

1. 6/m concurrant chronic conditions
2. 12/m doses of drugs/day
3. 9/m meds
4. Prior adverse drug event
5. Low body weight
6. > 85 y/o
7. CrCl

Question 11

Beers top drugs to avoid

Answer 11

1. Diphenhydramine, hydroxyzine, 1st gen antihistamines
2. Clonidine
3. Amiodarone, class 1 antiarrythmic drugs
4. Digoxin > 0.125 mg
5. All BDZ
6. Glyburide, chlorprompramide
7. Indomethacin, meperidine

Question 12

To pee or not to pee

• parasympathetic
• Alpha

Answer 12

To pee:
Parasym (+)
Alpha (-)

Not to pee:
Parasym (-)
Alpha (+)

Question 13

Antihistamine + Alpha adrenergic FX on bladder control

Answer 13

Antihistamine:
anticholinergic properties:
- decrease detrusor contractility

Alpha adrenergic agent:
- stimulate contraction of internal urethral sphincter preventing outflow obstruction
(worse if they have enlarged prostate)

Question 14

Why do you have to taper cessation of amitriptyline and clonidine?

Answer 14

Amitriptyline:
can cause cholinergic rebound syndrome
(agitation, diarrhea, stomach gas)

Clonidine:
can cause rebound HTN

Question 15

*What is the relative risk reduction, absolute risk reduction, and NNT? Which is most important?

Answer 15

NNT most important
NNT = 1/ARR

Next most imp is ARR ( diff in risk attributable to intervention)

ARR =
c/c+d - a/a+b
(incidence control - incidence Rx)

Question 16

RALES trials in pts w/ severe CHF

- problem with silo thinking

Answer 16

Spirinolactone in addition to std therapy with ACEi and diuretic (and digoxin) substantially reduces risk of both morbidity and death among pts w/ severe HF
- but found increased rate of hospitalization for hyperkalemia, and no change in decline for hospital readmission for CHF

Question 17

HYVET vs SPRINT

Answer 17

Hyvet:
treating HTN >160/90 in pts >80 reduces all cause mortality

SPRINT:
Aggressive tx of HTN to target BP 50 y/o are at increased cardiovascular risk

Question 18

Time to see benefit in ACEi in diabetes

Answer 18

see benefit of slowing progression of renal disease (decline in creatinine clearance) in as little as ONE YEAR