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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?

24
Q

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

25
What factors among elderly increases ADR likelyhood?
- 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
5 guidelines to avoid ADRS
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
Avoid sedative hypnotics for treatment of ...
insomnia, agitation, delerium
28
Use sedative hypnotics in elderly for..
GAD, seizure, anesthesia, withdrawl, EOL
29
What Benzos are you to use in the elderly
Ones with short 1/2 lived | -Lorazepam-Oxazepam
30
Propocyphene and Pentazocine
Removed from Beers list
31
what is the elderly response to 1st and 2nd generation antipsychotics?
Increased
32
Why is the black box warning important for the elderly? (what is it)
-causes strokes and mortality in people with dementia
33
When do you use antipsychotics in the elderly?
-psychosis | NOT DEMENTIA
34
Which type of anti-depressant is used in the elderly population?
SSRIs
35
Which antidressive group is avoided in the elderly?
TCAs
36
Anticholinergic in the elderly
-increased side effects
37
What anticholinergics should be avoided?
``` antidiarrheals 1st gen. antihistamines antispasmodics skeletal muscle relaxants class 1a, 1c, 3 antiarrythmics antiemetics ```
38
What do you need to be careful about when using antihypertensives in the elderly?
They have an increased response and side effects
39
Treatment approach for HTN in the elderly
Diuretics CCBs BBS and ACEi - not as useful chech othostatic hypotension
40
Digoxin in elderly
-they are more susseptible to the dig induced arythmias - only use if clear indication - dose must be under 125
41
ABX 1/2 life in elderly
increased bc excreted rnealy
42
The excretion ABX principal is most profound with which three ABX groups?
- aminoglycosides - betalactams - fluorquinolones
43
Skeletal muscle relaxants
-poorly tolerated, anticholinergic effects, sedative effects, fall and fracture effects
44
NSAIDs in elderly
INCREASED RISK OF GI BLEEDING | chekc serum CR
45
Insulin
avoid sliding scale-> hypoglycemia
46
Chlorpropamide
increase 1.2 life -> hypoglycemia
47
Glyburide
hypoglycemia
48
Alzheimers Disease results from what?
Destruction of CHOLINERGIC neurons
49
What are the two appraoches to Alzheimer's treatment?
1) cholinergics | 2) neurotoxins
50
pathology in alzheimer pts
Decrease choline acetyltransferace enzyme (makes ACTH) and not enough acetylcholine
51
Glutamate
-excitatory NT but also neurotoxic if in synapse to long
52
NMDA Receptor blocker N methyl-D-asparate) Mematine
decreased glutamate and brain injury from glutamate
53
3 Cholinesterase inhibitors used in Alzheimer's
- Donepizil - Rivastigmine - Glantamine
54
Mild/moderate Alzheimers treat with...
cholinesterase inhibitors
55
Moderate to Sever Alzheimer's treatment
Mematine -NMDA vlocker

pharm exam 3 summer (4 decks)

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