Geriatric Pharmacology Flashcards
what are the chances in body composition with aging?
dec muscle size and mass
reduction in water and lean muscle
increased body fat %
what are the GI changes in aging?
dec fxn of gastroesophageal sphincter
dec gastric acid secretion and emptying
thinning of GI mucosa
dec liver size and blood flow
what are the changes in the genitourinary system with aging?
Dec renal mass and glomeruli
changes in bladder
what are the chances in the CV system with aging?
fibroelastic thickening
dec baroreceptor sensitivity
what are the neuromuscular and musculoskeletal changes with aging?
Dec brain volume
more permeable BBB
dec bone mineral density
dec in homeostatic control
what is the consequence of increased body fat in aging?
increased storage of lipid soluble drugs
what is the consequence of decreased plasma proteins in aging?
increased water soluble drugs free floating leads to an increase in their effects
what leads to altered drug absorption in aging?
dec gastric acid
dec stomach emptying
dec absorbing area
dec motility
what contributes to altered drug distribution in aging?
dec water
inc body fat
dec lean body mass
dec plasma proteins
what contributes to changes in hepatic metabolism in aging?
dec liver mass
dec liver blood flow
dec enzyme activity
what contributes to changes in renal excretion in aging?
dec kidney mass
dec kidney blood flow
dec tubular fxn in nephron
what are the 3 pharmacodynamic changes w aging?
1) changes in drug receptor affinity
2) changes in coupling mechanism
3) changes in biochemical events
what are the pharmacodynamic changes w Ca2 channel blockers in aging?
inc sensitivity to vasodilation
dec HR and BP
what are the pharmacodynamic changes w beta blockers in aging?
reduced beta adrenergic receptors fxn
reduced responses to beta antagonists
dec therapeutic effect w/beta blockers
what are the pharmacodynamic changes w anticoagulants in aging?
greater inhibition of synthesis of clotting factors
greater risk of bleeding
what are the pharmacodynamic changes w anticholinergics in aging?
impaired cognition in pts w/cholinergic deficit
what are the pharmacodynamic changes w bezos in aging?
inc postural sway
stronger sedative effects
what are the pharmacodynamic changes w anesthetic agents in aging?
inc sensitivity to propofol and opioids
what are the pharmacodynamic changes w antipsychotics in aging?
inc effects
extrapyramidal symptoms, arryhthmias, postural hypotension
in aging is the response to beta-agonists increased or decreased?
decreased
in aging is the response to beta blockers increased or decreased?
decreased
in aging is the response to Ca2+ channels blockers increased or decreased?
increased
in aging is the response to loop diuretics increased or decreased?
decreased
in aging is the response to vit K antagonists increased or decreased?
increased
in aging is the response to morphine increased or decreased?
increased
in aging is the response to propofol increased or decreased?
increased
in aging is the response to antipsychotics increased or decreased?
increased
in aging is the response to benzos increased or decreased?
increased
there is a greater variability in drug responses due to changes in …
organ fxn
body comp
fragility
comorbidity
pharmacogenetic factors (genotypes)
what is polypharmacy?
5 or meds taken daily
polypharmacy increases the risk of…
drug interactions
overdose
toxicity
dosing errors
what are characteristics of polypharmacy in older adults?
use of meds for no reason
use of duplicate meds
concurrent use of interacting meds
use of contrindicated meds
use of inappropriate dosage
use of drug therapy to Rx adverse drug rxns
what are the s/s of common adverse drug rxns?
GI symptoms
sedation
confusion
depression
OH
fatigue and weakness
dizziness and falls
anticholinergic effects
extrapyramidal symptoms
what are other factors that increase the risk of adverse drug reactions in older adults?
comorbidities
lack of proper drug testing w/older subjects
lack of pt education
nonadherence to drug regimen
use of inappropriate meds
what is Beer’s criteria?
a list of drugs that are likely to make the pt more confused, inc fall risk, inc likelihood of side effects/toxicity
pts should be adequately monitored and benefits should outweigh the risks
