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pharm exam 3 summer > Geriatric Pharm > Flashcards

Geriatric Pharm Flashcards

1
Q

4 Key pharmacokinetic changes with age

A

1) Absorption
2) Distribution
3) Metabolism
4) Elimination

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2
Q

What % of drugs are used in geriatric pts?

A

50%

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3
Q

what % of geriatric pts. have ADRS and what % of this are preventable

A

10, 40

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4
Q

Absorption of Drugs

A

-often slower rate, but total amount absorbed is the same

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5
Q

What is the effect of DM on Absorption?

A

-DM causes slow gastric emptying which leads to prolonged absorbtion

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6
Q

What drugs commonly used in the eledery alter absoprtion?

A

laxitives and antacids

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7
Q

What three vitamins have decreased absoprtion in the elderly?

A

B12, calcium, Iron

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8
Q

How is the loading dose of water soluble drugs altered in the elderly?

A

lower water, lower loading dose

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9
Q

Old age effects fat soluble drugs how?

A

increased acumulation and longer duration of action

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10
Q

Benzos are fat soluble how does this translate in older people?

A
  • longer duration of action

- also increased concentrations in brain

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11
Q

CHF and metabolism

A

CHF causes decreased blood flow to the liver which decreases metabolism

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12
Q

Morphine and propranolol

A

-clearence is drasticaly reduced-> ADR of respiratory supression

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13
Q

What is THE MOST IMPORTANT CHANGE that affects drug ussage in elimination?

A

kidney function

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14
Q

What do we need to be aware of when treating the elderly as far as renal and elimination ?

A

CR may be normal in patients with low renal function b/c these pts. have decreased muscle mass

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15
Q

What are two strategies in preventing ADRs related to decreased excretion?

A
  • increased dosing interval- preferred method

- decrease dose

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16
Q

There is a change in receptor affinity and number in the elderly. This is related to the elderly being more sensitive to which 3 drug groups and less responsive to which drug group?

A

MORE sensitive: benzos, opiates, warfarin

LESS sensitive: beta blockers

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17
Q

With age there are homeostatic responses. what are these?

A
  • decreased barroreceptor response
  • NA and H2O conservation
  • decreased mobility and balance
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18
Q

Blood Pressure in Elderly

A
  • orthostatic hypotension

- may seem mor sensitive to BP meds but in reality their body just doesent have sound barroreceptors

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19
Q

Blood Sugar in Elderly

A
  • we loose the ability to handle carb -> increased sugar

- patients seem resistant to diabetic meds

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20
Q

Economics

A
  • most elderly on fixed income

- medicare covers some med cost

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21
Q

3 types of Noncompliance

A
  • forgetfulness
  • confusion
  • intellignet non compliance
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22
Q

Physical dissability

A
  • cant get to pharmacy
  • can see pills
  • decreased saliva
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23
Q

What is the chance of a drug interaction if a patient is taking 10 drugs?

A

100%

24
Q

What is the average number of drugs an old person takes?

A

12

25
Q

What factors among elderly increases ADR likelyhood?

A
  • low weight
  • > 85
  • decrease renal function
  • presence of 6 or mor ilnesses
  • ADR hx
  • on 9 or more meds or tak 12 doses/ day
26
Q

5 guidelines to avoid ADRS

A

1) drug hx
2) only use meds for their indications
3) define goal of each med
4) high suspesion of ADR
5) simplify drug routien

27
Q

Avoid sedative hypnotics for treatment of …

A

insomnia, agitation, delerium

28
Q

Use sedative hypnotics in elderly for..

A

GAD, seizure, anesthesia, withdrawl, EOL

29
Q

What Benzos are you to use in the elderly

A

Ones with short 1/2 lived

-Lorazepam-Oxazepam

30
Q

Propocyphene and Pentazocine

A

Removed from Beers list

31
Q

what is the elderly response to 1st and 2nd generation antipsychotics?

A

Increased

32
Q

Why is the black box warning important for the elderly? (what is it)

A

-causes strokes and mortality in people with dementia

33
Q

When do you use antipsychotics in the elderly?

A

-psychosis

NOT DEMENTIA

34
Q

Which type of anti-depressant is used in the elderly population?

A

SSRIs

35
Q

Which antidressive group is avoided in the elderly?

A

TCAs

36
Q

Anticholinergic in the elderly

A

-increased side effects

37
Q

What anticholinergics should be avoided?

A 
antidiarrheals
1st gen. antihistamines
antispasmodics
skeletal muscle relaxants
class 1a, 1c, 3 antiarrythmics
antiemetics
38
Q

What do you need to be careful about when using antihypertensives in the elderly?

A

They have an increased response and side effects

39
Q

Treatment approach for HTN in the elderly

A

Diuretics
CCBs
BBS and ACEi - not as useful
chech othostatic hypotension

40
Q

Digoxin in elderly

A

-they are more susseptible to the dig induced arythmias

  • only use if clear indication
  • dose must be under 125
41
Q

ABX 1/2 life in elderly

A

increased bc excreted rnealy

42
Q

The excretion ABX principal is most profound with which three ABX groups?

A
  • aminoglycosides
  • betalactams
  • fluorquinolones
43
Q

Skeletal muscle relaxants

A

-poorly tolerated, anticholinergic effects, sedative effects, fall and fracture effects

44
Q

NSAIDs in elderly

A

INCREASED RISK OF GI BLEEDING

chekc serum CR

45
Q

Insulin

A

avoid sliding scale-> hypoglycemia

46
Q

Chlorpropamide

A

increase 1.2 life -> hypoglycemia

47
Q

Glyburide

A

hypoglycemia

48
Q

Alzheimers Disease results from what?

A

Destruction of CHOLINERGIC neurons

49
Q

What are the two appraoches to Alzheimer’s treatment?

A

1) cholinergics

2) neurotoxins

50
Q

pathology in alzheimer pts

A

Decrease choline acetyltransferace enzyme (makes ACTH) and not enough acetylcholine

51
Q

Glutamate

A

-excitatory NT but also neurotoxic if in synapse to long

52
Q

NMDA Receptor blocker N methyl-D-asparate)

Mematine

A

decreased glutamate and brain injury from glutamate

53
Q

3 Cholinesterase inhibitors used in Alzheimer’s

A
  • Donepizil
  • Rivastigmine
  • Glantamine
54
Q

Mild/moderate Alzheimers treat with…

A

cholinesterase inhibitors

55
Q

Moderate to Sever Alzheimer’s treatment

A

Mematine -NMDA vlocker

pharm exam 3 summer (4 decks)

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