Geriatric Pharm

Question 1

Principle causes of drug-related problems in the elderly (name some(

Answer 1

Drug interactions
Inadequate monitoring
Inappropriate drug
Lack of adherence
Overdosage
Under prescribing
Untreated medical problem

Question 2

Tools for Medication Decisions in older adults (3)

Answer 2

Beers

STOPP

START

Question 3

What is the Beers list?

3 categories?

Answer 3

medications likely to cause adverse effects in elderly

High risk
Moderate
Some risk

Question 4

Body comp changes that affect drug therapy

Answer 4

decrease body water
decreased lean body mass
increased body fat

Question 5

Cardiovascular changes that affect drug therapy

Answer 5

decreased myocardial sensitivity to Beta-stimulation
decreases baroreceptor activity
decreased cardiac output
increased total peripheral resistance

Question 6

Liver changes that affect drug therapy

Answer 6

Decreased hepatic size

Decreased hepatic blood flow

Question 7

Renal changes that affect drug therapy

Answer 7

Decreased glomerular filtration rate
Decreased renal blood flow
Decreased filtration fraction
Decreased tubular secretory function
Decreased renal mass

Question 8

What are the four primary functions associated with pharmacokinetics? (which is least affected by aging?)

Answer 8

Absorption*** (least affected by aging)
First pass metabolism
Distribution
Metabolism

Question 9

What is the significance of first pass metabolism in elderly?

Answer 9

reduced

lower dose requirements for drugs inactivated by first pass metabolism

potentially higher dose requirements for drugs activated by first pass metabolism

Question 10

What effect do the body comp changes in elderly (decreased water and lean mass, increased fat) have on drug distribution?

Answer 10

Lipophilic drug has HIGHER Vd

Water soluble drug has a LOWER Vd

Muscle binding drugs (digoxin) have LOWER Vd

Question 11

What effect does Vd have on half life?

Answer 11

Increased Vd = Increased half life

Decreased Vd = decreased half life

Question 12

What effect does Vd have on loading dose?

Answer 12

Increase Vd = increased loading dose

Decreased Vd = decreased loading dose

Question 13

Effects of aging on the liver and hepatic drug clearance

Answer 13

CL(h) = Q x E

Extraction rate decreased due to DECREASED PHASE I ENZYMES (for drugs that are metabolized by phase I)

Q - Blood flow decreases with aging

Question 14

Flow rate limited drugs in the elderly

Capacity limited drugs in the elderly

Answer 14

REDUCED HEPATIC CLEARANCE (generally)

DECREASED CLEARANCE if metabolized by phase I

Question 15

Changes in hepatic clearance effect on maintenance dose?

Answer 15

NO CHANGE for capacity limited drugs of Phase II metabolism

Decrease maintenance dose for capacity limited drugs of Phase I metabolism

Decrease maintenance dose in flow rate limited drugs

Question 16

What is measured to monitor glomerular filtration rate (GFR)?

Answer 16

Creatinine

Question 17

What occurs with creatinine levels in the elderly?

Answer 17

decreases due to decreased muscle mass

Question 18

What are the most significant parameters that increase half life in elderly? (2)

Answer 18

decreased hepatic and decreased renal clearance

Question 19

Pharmacodynamic changes with aging

Answer 19

Decreased cardiac and vascular beta adrenergic responsiveness = decreased beta-blocker responsiveness

Exaggerated acute blood pressure response to calcium channel blockers

Increased sensitivity to anesthetic agents

Question 20

Drugs with increased adverse effects with elderly

Answer 20

NSAID’s

Anti-cholinergic drugs (or drugs with anti-cholinergic properties; anti-convulsants, anti-depressants, anti-histamines, anti-psychotics, GI anti-spasmodics, H2 antagonists, Muscle relaxants, parkinson drugs, urinary anti-spasmodics, vertigo drugs)

Question 21

NSAID’s dangers with elderly

Answer 21

RENAL DAMAGE

GI bleeding and irritation