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life cycles test III > geriatric and pediatric pharm > Flashcards

geriatric and pediatric pharm Flashcards

1
Q

define age ranges for premature, neonatal, infants, children, adolescents, geriatric

A

Premature: born before 37 weeks gestational age. Neonatal: 1 day-1 month. Infants: 1 month-1 year. Pediatric - children 1-11 years. Adolescent: 12-16 years. Geriatric: > 65 years

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2
Q

pediatric absorption

A

By 1 year of age, adult-child differences NOT substantial

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3
Q

pediatric volume of distribution

A

Body proportions and fat distribution change with age, but effect on Vd for most drugs is relatively minor. Loading doses change little

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4
Q

pediatric hepatic metabolism- list phase 1 pathways and when they reach adult levels

A

CYP1A2: 4-5 months. CYP2C9: teens (<30% at birth). CYP2D6: 10 years (no activity at birth). CYP3A4: 1 year (30-75% at birth).

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5
Q

List substrates for CYP1A2, CYP2C9, CYP2D6 and CYP3A4

A

CYP1A2: caffeine, theophylline. CYP2C9: NSAIDS, Warfarin. CYP2D6: antidepressants, opioid analgesics. CYP3A4: statins, calcium channel blockers

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6
Q

pediatric hepatic metabolism- list phase 2 pathways and when they reach adult levels

A
  1. sulfate and glycine conjugation- at birth. 2. acetylation- 2 yrs. 3. glucuronide conjugation- 2-3 yrs (0-25% at birth). This is the cause of grey baby syndrome with chloramphenicol
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7
Q

pediatric renal function maturation

A

Adult level functioning is achieved by 5 months for renal blood flow, 6 months for tubular sec and 3 years for GFR

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8
Q

compare renal vs hepatic clearance of drugs in children

A

renal clearance is more predictable and renally excreted drugs are cleared more rapidly. Hepatic elimination varies widely in children

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9
Q

pediatric maintenancedoses

A

Drugs are cleared more rapidly in children (in general), whether eliminated via renal or hepatic processes. Maintenance doses (calculated on a mg/kg/day basis) are often higher than encountered in adults

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10
Q

pediatric therapeutic levels of drugs (Cp)

A

Therapeutic levels of drugs (Cp) in children same as adults. Calculated based on weight

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11
Q

drugs that affect growth in kids

A

Most psychoactive agents have modest effects on growth. Anti-inflammatory corticosteroids (including topical agents) are potent inhibitors of growth

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12
Q

drugs that affect intellectual development in kids

A

barbiturates

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13
Q

side effects of tetracyclines in kids

A

are incorporated into growing bone and teeth and are contraindicated in children and in pregnancy

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14
Q

Aspirin side effects in kids

A

not recommended for use in children prior to puberty because of risk for hepatic dysfunction: Reyes syndrome- fatty liver with acute encephalopathy. Aspirin interaction with chicken pox and influenza

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15
Q

List drugs that have potential for life threatening sx in young children

A

Benzonatate, iron, antidepressants, antipsychotics, antimalarials, antiarrythmics, Ca channel blockers, sulfonylurea hypoglycemics, opioids, acetaminophen, diphenhydramine

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16
Q

geriatric changes in absorption

A

Rate of absorption changes slightly but extent of absorption (bioavailability) is unchanged. increased gastric pH, decreased absorptive surface, splanchnc blood flow, GI motility and gastric emptying rate

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17
Q

geriatric changes in distribution

A

decreased cardiac output, hepatic/ renal blood flow, body fat (changes volume of distribution), total body water, relative tissue perfusion and albumin

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18
Q

geriatric changes in metabolism

A

decreased liver mass, hepatic blood flow and enzyme activity (changes clearance rate)

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19
Q

geriatric changes in excretion

A

decreased renal blood flow, decreased GFR (changes clearance), tubular secretion and renal mass

20
Q

how does decreased gastric acid affect drug absorption in geriatrics

A
  1. Decrease in absorption of weak acid drugs (e.g., warfarin, penicillin). 2. Increase in absorption of weak base drugs (e.g., TCADs, benzodiazepines, opioid analgesics, anticonvulsants). 3. Inappropriate (early) release of enteric-coated drugs (e.g., aspirin)
21
Q

List disease which may affect absorption

A

CHF: slowed or reduced absorption. Gastroparesis: decreased gastric emptying and GI motility

22
Q

list drugs/ drug properties which may affect absorption

A
  1. drugs that decrease gastric emptying/ motility- anticholinergics like diphenhydramine and TCADs. 2. drugs that increase gastric emptying/ motility- metoclopramide, cisapride, stimulant laxatives. 3. drugs that decrease absorption by interacting in the guy- ie. cholestyramine binds warfarin
23
Q

drugs which have a decreased Vd in geriatrics

A

Water soluble drugs will have decreased Vd due to decreased total body water. This increases plasma concentrations of these drugs. Ie. digoxin, aminoglycosides, lithium. This may lower the loading dose

24
Q

drugs which have an increased Vd in geriatrics

A

lipid soluble drugs have increased Vd due to increased body fat. This causes slower elimination, increased half life and drug accumulation. Ie. Chlordiazepoxide and diazepam. May require lower maintenance dose

25
Q

How do geriatric serum albumin levels affect distribution

A

decreased albumin Can result in increase in free (active) drug concentrations of highly protein bound drugs like phenytoin, phenobarbital, warfarin and diazepam.

26
Q

describe drug metabolism in general

A

lipophilic drug undergoes phase 1 enzyme action (CYP450) to form hydrophilic less active compound. This then undergoes phase II glucuronidation or conjugation to form highly water soluble, inactive substrate

27
Q

how do phase I and phase II reactions change in geriatrics

A

Phase I reactions (oxidation, reduction, hydrolysis) decrease with age in 30-35% of elderly patients. Drugs like chlordiazepoxide and diazepam will have an increased plasma half life. Phase II reactions (conjugation, glucuronidation) are minimally affected by aging. This includes lorazepam, oxazepam, temazepam

28
Q

Which benzodiazepams are preferred in elderly

A

Lorazepam / oxazepam are preferred over diazepam / chlordiazepoxide due to their phase II metabolism

29
Q

Dosing of renally excreted drugs in geriatrics

A

Drugs eliminated primarily by the kidneys will accumulate in the presence of renal impairment. Use renal dosing based on creatinine clearance

30
Q

equation for creatinine clearance

A

[(140-age) x (Kg) x 0.85 (females)] / (serum creatinine x 72)

31
Q

Beers criteria

A

Addresses inappropriate drugs regardless of diagnosis- conditions OR drug use in certain diagnosis-condition for elderly patients.

32
Q

Worst drugs from the Beers criteria

A

amitriptyline, diazepam, doxepin

33
Q

Beers criteria- drugs to avoid in HTN

A

pseudoephedrine, methylphenidate

34
Q

Beers criteria- drugs to avoid syncope or falls

A

benzos, TCADs

35
Q

List drugs that worsen arthralgias, myopathies and osteoporosis

A

Worsened by corticosteroids, phenytoin, heparin-warfarin, decreased vitamin D intake

36
Q

list drugs that worsen movement disorders

A

Worsened by dopamine receptor blockers: antipsychotic agents, metoclopramide

37
Q

list drugs that worsen tinnitus and vertigo

A

Worsened by aspirin, aminoglycosides, ethacrynic acid

38
Q

list drugs that worsen hypotension

A

Worsened by beta-blockers, calcium channel blockers, diuretics, vasodilators, antidepressants

39
Q

list drugs that worsen psychomotor retardation

A

Worsened by benzodiazepines, antihistamines, antipsychotic agents, antidepressants

40
Q

receptors involved in urination

A

GO: stimulate Muscarinic receptors (bladder and neck), block alpha 1 receptors (trigone). Stop: block M or stimulate alpha1, Beta2 or 3 (bladder)

41
Q

list drugs that worsen urinary retention and overflow

A

Worsened by anticholinergic agents, agents with anticholinergic side effects (tricyclic antidepressants, antihistamines, typical antipsychotic agents), smooth muscle relaxants, a -adrenergic agonists. Treated with tamsulosin (flomax), a alpha-adrenergic antagonist

42
Q

List drugs that worsen stress incontinence

A

a-adrenergic antagonists (prazosin, doxazosin)

43
Q

list drugs that worsen urge incontinence due to detrusor hyperreflexia (overactive bladder)

A

Worsened by cholinergic drugs for dementia (AChEIs), diuretics. Treated with: antimuscarinic agents [tolterodine]

44
Q

List drugs that worsen constipation

A

Worsened by opioid analgesics, antimuscarinic agents, 1st gen antihistamines (esp. diphenhydramine), CCBs- verapamil

45
Q

List drugs that cause metabolic alterations leading to mental state dysfunction

A

Metabolic alterations with beta-blockers, corticosteroids, diuretics, sulfonylureas

46
Q

list drugs that cause cognitive impairment

A

opioid analgesics, cimetidine, propranolol, antipsychotic agents, anticonvulsants, BDZs

47
Q

list drugs that cause behavioral toxicity

A

anticholinergics, cimetidine, l-dopa, digoxin, opioid analgesics, β-blockers, corticosteroids

life cycles test III (13 decks)

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