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Pharmacology 5 > Geriatric pharm > Flashcards

Geriatric pharm Flashcards

1
Q

What are some tools for medication decisions in older adults

A

BEERS LIST

  • list of medications likely to cause adverse effects in elderly
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2
Q

phsyiological changes of aging in body composition

A
  • decrease total body water
  • decrease lean body mass
  • increase BODY FAT
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3
Q

phsyiological chagnes associated in cardiovascular

A
  • decrease myocardial sensitivity to Beta-adrenergic stimualtion
  • Decrease baroreceptor activity
  • decrease cardiac output
  • increase total peripheral resistance
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4
Q

physiological changes asocaited with aging in liver

A
  • decrease hepatic size
  • decrease hepatic blood flow
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5
Q

physiological changes assocaited with pulmonary function

A
  • decrease
    • respiratory muscle strength
    • chest wall compliance
    • total alveolar surface
    • vital capacity
    • maximal breathing capacity
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6
Q

physiooigical changes assocaited with aging in renal

A
  • decrease
    • glomerular filtration rate
    • renal blood flow
    • filtration fraction
    • tubular secretory function
    • renal mass
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7
Q

phsyiological changes associated with aging in skeletal system

A

loss of skeletal bone mass (OSTEOPENIA)

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8
Q

phsyiological changes in elderly that can affect pharmacokienetics

A
  • absorption = LEAST affected by aging
  • First-pass metabolism = reduced with aging
  • Distribution = differences in body composition
  • Metabolism/clearance
    • reduced liver function and blood flow
    • reduced kidney function
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9
Q

describe effect of first pass metabolism on plasma drug conc

A
  • First pass metabolism is often reduced in elderly
    • potentially a lower dose requirement in elderly with drugs that are inactivated by first pass metabolism
    • Potentially a HIGHER dose required in elderly with PRODRUGS that require activation by first pass liver metabolism
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10
Q

Age related changes that affect volume of distribution

A
  • Tissue binding properties
    • drugs which are tightly bound to tissue have LARGE Vd
    • ELDERLY = decrease lean body mass and increase adiposity
      • drugs bound to muscle have DECREASE Vd with aging
        • DECREASE LOADING DOSE REQUIRED
  • Lipid water coefficient
    • lipid soluble drugs have HIGHER Vd than water soluble drugs
    • ELDERLY = INCREASE body fat and DECREASE in body WATER
      • INCREASE Vd for lipid soluble drugs and DECREASE Vd for water soluble drugs
        • Loading dose DECREASE in WATER SOLUBLE
        • INCREASE half life in FAT SOLUBLE
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11
Q

age related effects on hepative drug clearane

A
  • EFFECTS OF AGING ON LIVER
    • decrease blood flow
    • reduced activity of phase I enzymes (cytochrome p450)
    • NO EFFECT ON PHASE II ENZYME
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12
Q

capacity limited hepatic clearance

A
  • Capcity limited
    • drug whose hepatic clearance rate-limiting step is liver enzyme function
    • clearane capacity limited drug is NOT AFFECTED by how fast the drug can get to the liver cells (flow rate)
  • NO Change in an elderly patient hepatic clearance of a capacity limited drug if it metabolized by phase II enzymes
  • DECREASED CLEARANCE if metabolized by PHase I enzymes
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13
Q

FLOW RATE LIMITED

A
  • drug whose rate-limiteing hepatic clearance step is FLOW RATE (how fast it can get to liver cells)
  • HAVE REDUCED HAPTIC CLEARANCE IN ELDERLY PATIENTS
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14
Q

drugs effect of hepatic clearance on maintenance doses

A
  • REduce in hepatic clearance of drug requries LESS FREQUENT and LOWER MAINTENANCE DOSE
    • NO CHANGE in maintenance dose for CAPACITY LIMITED DRUGS that are metabolized by phase II enzymes
    • DECREASE in maintenance dose in CAPACITY LIMITED DRUGS that are metabolized by PHASE I enzymes
    • DECREASE in maintenance dose in FLOW RATE LIMITED DRUGS
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15
Q

describe renal clearance

A
  • Renal excretion is DECREASED IN ELDERLY INDIVIDUALS
    • Glomerular filtration rate (reduced by 15-40%
    • Tubular secretion (polypharm increases risk of drugs competing for active transporters
  • CREATINE CLEARANCE is an INDEX OF GLOMERULAR FILTRATION RATE (GFR)
    • conc in blood INCREASES and conc in urine DECREASES as renal function DECREASES
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16
Q

describe cockroft and gault equation

A
  • Elderly individuals will have LESS SERUM CREATININE because of DECREASED MUSCLE MASS
    • even with decreased GFR they can have the same plasma creatinine conc as a younger individual with normal GFR
  • CROCKCROFT AND GAULT equation accounts for decreased muscle mass in elderly patients
17
Q

describe the general pharmacokinetic changes with aging

GI

distribution

hepatic metabolism

renal excretion

A
  • GI absorption = decrease first-pass extraction and increase bioavailability for some drugs
  • Distribution
    • decrease volume of distribution and increase plasma conc of WATER SOLUBLE DRUGS
    • Increase volume of distribution and increase terminal disposition half life for FAT SOLUBLE DRUGS
  • hepatic metabolism
    • Decrease clearance and increase half life for PHASE 1 METAB
    • decrease clearance and increase half life for FLOW LIMITED
  • Renal excretion = decrease clearance and increase half life for renally eliminated drugs
18
Q

describe homeostatic control mechanisms that decrease in elderly

A
  • enhanced sensitivity to postural hypotension
  • gait disorders
  • reduced thirsta nd volume regulation
  • reduced glucose and electrolyte control
  • reduced thermoregulation
  • increased sensitivity to anesthetic agents
  • decreased Beta-adrenergic responsiveness
19
Q

NSAID in geriatric pts

A
  • Elderly are very susceptible to toxicities of NSAIDs
    • CLEARED By KIDNEYS
    • Renal blood flow becomes reduced with aging
      • increases in prostaglandins help increase blood flow and maintain glomerular filtration rate –> NSAIDS block increase prostaglandins
  • ALSO CAUSES GI BLEEDING AND IRRITATION
20
Q

Anticholinergic drugs

A
  • Dry mouth, decrease gut motility, bladder hypotonia, decreased cognition, sedation, ORTHOSTATIC HYPERTENSION, BLURRY VISION
    • lead to increase risk of falls and impaired cognition

Antidepressants, antihistamines, muscle relaxants, parkinsons disease, urinary antispasmodics

Pharmacology 5 (10 decks)

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