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Endocrine Pharm > Geriatric Pharmacology > Flashcards

Geriatric Pharmacology Flashcards

1
Q

How can we avoid the drug AA cascade?

A
  • Avoid prescribing until test results confirm suspected diagnosis
  • Start with low dose then titrate
  • Avoid starting multiple meds at the same time
  • Reach theraputic dose b4 switching or ading agents
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2
Q

What is the drug AA cascade?

A

Drug 1 => AA 1 confused as new disease =>Drug 2 = AA 2 confused as new disease

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3
Q

What are the causes of drug related problems?

A 
Drug interactions
Inadequate monitoring
Innapropriate drug selection
Innapropriate Tx
Lack of Pt adherence
Overdosage
Under Prescribing
unTx medical Problem
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4
Q

What are the tools for medication decisions in older adults?

A

Beers Criteria
STOPP
START

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5
Q

What are the physiological changes that come with aging?

A

Inc. Waist Circum then plateau or decline
Increase Fat Mass

Dec. weight
Dec. LBM

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6
Q

What are the physiologic changes in the liver associated with age?

A

Dec. Hepatic size

Dec. Hepatic BF

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7
Q

What are the physiologic changes in the Lungs associated with age?

A 
Dec. Respiratory Muscle Strength
Dec. Chest wall compliance
Dec Total alveolar surface 
Dec. Vital Capacity
Dec. Maximal breathing capacity
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8
Q

What are the physiologic changes in the kidneys associated with age?

A 
Dec GFR
Dec Renal Blood Flow
Dec Filtration fraction
Dec. Tubular secretory function
Dec Renal Mass
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9
Q

What are the physiologic changes in the skeleton associated with age?

A

Loss of skeletal bone mass

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10
Q

What are the physiologic changes in the body composition associated with age?

A

Dec. Total body water
Dec Lean body mass
Inc Body Fat

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11
Q

What are the physiologic changes in the cardiovascular system associated with age?

A

Dec Myocardial Sensitivity to B adrenergic stim
Dec. Baroreceptor Activity
Dec. Cardiac output

Increased Total Peripheral resistance

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12
Q

What are the parameters involved in pharmacokinetics?

A

Absorption
Distribution
Metabolism
Clearance/Elimination

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13
Q

What paramenter is least effected by aging?

A

Absorption

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14
Q

What is first pass inactivation?

A

Before entering systemic circulation a drug can be metabolized(inact) in the gut wall or liver, more commonly.

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15
Q

What hapens to first pass metabolism in the elderly?

A

Decreased therefore,

they will need less drug to have the same theraputic effect

May need more of a drug that requires hepatic activation

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16
Q

What is the equation for volume of distribution?

A

Vd= amt of drug in body/plasma drug conc.

17
Q

What happens to the Vd of a muscle bound drug in elderly pop?

A

It will decrease

18
Q

What happens to the kinetics of Lipid sol. drugs in elderly?

A

Longer HL

19
Q

What is the clearance of a drug?

A

Rate of elimination of a drug from the body in relation of drug conc.
CL = Q x E
Q=flow rate to organ
E = Extraction ratio

20
Q

What is the size of the maitenence dose?

A

Maint rate is equal to rate of clearance at steady state

Requires less frequent and lower maint dose

21
Q

What is the chemical of choice to measure Renal clearance?

A

Creatinine is filtered and not reabsorbed

Creatinine clearance is an index of GFR

22
Q

How is the Creatinine Clearance measured?

A

Compare 24 hr urine collection concentration to serum conc.

Blood conc increases and Urine conc decreases as renal function decreases

23
Q

What is the purpose of the Cockroft and Gault equation

A

Accounts for decreased muscle mass in elderly Pts

24
Q

What most significantly changes the T1/2 of drugs in the elderly?

A

Hepatic and renal clearance

25
Q

What happens to the clearance of FLOW LIMITED drugs in the elderly?

A

Dec Clearance and inc T 1/2

26
Q

What is the effect of aging on the B adrenergic system?

A

Decreases responsiveness to cardiac and vascular receptors

Dec response to Hypotensve effects of B Blockers

27
Q

What is the effect of Anesthetic sensitivity in the aging population?

A

Incresed sensitivity!

28
Q

What are considerations for NSAIDS in the elderly?

A

More succeptible to toxicity of NSAIDS
Renal damage
(cleared mostly by the kidneys)
Prostaglandins naturally increase in the elderly to retain perfusion to the kidneys

29
Q

What are the risks of Anticholinergic drugs in the elderly?

A

Orthostatic hypotension and blurry vision =>Fall risk increases

Endocrine Pharm (11 decks)

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