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Year 2 Pharmacology > Geriatric pharmacology > Flashcards

Geriatric pharmacology Flashcards

1
Q

what are four methods to prevent the prescribing cascade?

A
  1. wait to confirm suspected diagnosis
  2. start low and titrate up slowly
  3. avoid starting multiple medications
  4. reach therapeutic dose before switching or adding
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2
Q

what are three tools for medication decisions in older adults?

A

Beers Criteria
STOPP
START

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3
Q

what is STOPP used for?

A

to assess use of drug with specific patient with specific conditions

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4
Q

what is START used for?

A

to identify potential underuse of beneficial medications

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5
Q

what are the changes in body composition during the aging process?

A

decrease total body water
decrease lean body mass
increase body fat

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6
Q

what are the CV changes during the aging process?

A

decrease myocardial sensitivity to beta adrenergic stimulation
decrease baroreceptor activity
decrease CO
increase TPR

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7
Q

what are the liver changes during the aging process?

A

decrease hepatic size

decrease hepatic blood flow

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8
Q

what are the pulmonary changes during the aging process?

A 
decrease respiratory muscle strength 
decrease chest wall compliance 
decrease total alveolar surface area 
decrease vital capacity 
decrease maximal breathing capacity
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9
Q

what are the renal changes during the aging process?

A 
decrease GFR 
decrease renal blood flow 
decrease filtration fraction 
decrease tubular secretion function 
decrease renal mass
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10
Q

what are the skeletal changes during the aging process?

A

loss of skeletal bone mass

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11
Q

which variable of pharmacokinetics is least affected by aging?

A

absorption

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12
Q

which component of metabolism is decreased in the elderly?

A

first pass

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13
Q

in elderly patients with reduced first pass metabolism, should a higher or lower dose be used for a drug that is inactivated by first pass?

A

lower

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14
Q

in elderly patients with reduced first pass metabolism, should a higher or lower dose be used for a drug that requires activation by first pass?

A

higher

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15
Q

equation: volume of distribution

A

Vd = amount of drug in body / plasma drug concentration

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16
Q

what does a very large Vd indicate?

A

majority of drug distributes to the extravascular compartment

17
Q

what does a small Vd indicate?

A

drug is retained primarily in the vasculature

18
Q

gentamicin, a highly water soluble drug, will have what kind of Vd in the elderly? why?

A

decreased

less body water

19
Q

would a highly lipid soluble drug have an increased or decreased half life in an elderly patient when compared to a younger patient? why?

A

no change in half life

decreased Vd of a highly water soluble drug tends to be balanced by a reduction in clearance

20
Q

drugs bound to muscle have what kind of Vd in the elderly?

A

decreased

21
Q

definition: clearance

A

rate of elimination of a drug from the body in relation to drug concentration

22
Q

equation: clearance

A

CL = Q x E

23
Q

in capacity limited clearance, what it the rate limiting step?

A

liver enzyme function

24
Q

what is the rate limiting step in flow rate limited drugs?

A

how fast it can get to the liver cells (flow rate)

25
Q

what is the effect of polypharmacy on tubular secretion, physiologically?

A

increases risk of drugs competing for active transporters

26
Q

what molecule is an index of GFR?

A

creatinine

27
Q

why is the cockcroft and gault equation significant for elderly patients?

A

accounts for decreased muscle mass in elderly (decreased creatinine)

28
Q

what is the biggest effect of renal and hepatic clearance on half life?

A

increase

29
Q

what are the pharmacodynamic changes with aging on the beta adrenergic system?

A
  1. decreased cardiac and vascular responsiveness

2. decreased responsiveness of elderly individual to hypotensive effect of beta blockers

30
Q

what is the effect of acute BP response to calcium channel blockers in elderly patients?

A

exaggerated

31
Q

what is the effect of NSAIDs in the elderly population?

A

susceptible to toxicities (renal and hepatic)

GI bleeding and irritation

32
Q

which drugs can significantly increase the risk of falls in the elderly? why?

A

anticholinergics

decreased cognition, sedation, orthostatic hypotension, blurry vision

Year 2 Pharmacology (70 decks)

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