Geriatric Pharmacology

Question 1

Polypharmacy

Answer 1

multiple medications (usually 5-10)

Question 2

Pharmacokinetics

Answer 2

What the body does to the drug

1. Absorption
2. Distribution
3. Metabolism
4. Excretion

Question 3

Pharmacodynamics

Answer 3

What the drug does to the body

Question 4

Geriatric and topical route absorption

Answer 4

• thin epidermis
• less subcutaneous fat

=increased topical absorption

Question 5

Distribution

Answer 5

less body water –> higher serum level for hydrophilic drugs

more fat –> higher volume of distribution for lipophilic drugs (prolonged half life)

Less albumin in plasma –> more active, unbound drug

Question 6

Which phase of metabolism is most affected in the elderly?

Answer 6

Phase I (decreased metabolism)

ex. CYP450 3A4

Question 7

Geriatric pharmacokinetics: excretion

Answer 7

• GFR is reduced

- Decreased clearance

Question 8

What is digoxin dose based on?

Answer 8

• lean body mass

- renal function

Question 9

What percent of ADEs in elderly are avoidable?

Answer 9

25%

Question 10

Name the drugs most commonly involved in ADEs

Answer 10

1. Cardiovascular drugs
2. Diuretics
3. NSAIDs
4. Hypoglycemics
5. Anticoagulants

Question 11

Name some predictors of ADEs

Answer 11

• 6+ chronic conditions
• 9 or more meds
• Low body weight or low BMI
• 85 years or older
• GFR below 50mL/min (stage 3 and lower)

Question 12

What is the name for when a drug is prescribed to manage a side effect from another drug?

Answer 12

prescribeing cascade (bad!)

Question 13

What interaction is there between ACE/ARB and Septra?

Answer 13

hyperkalemia

Question 14

What interaction is between digoxin and macrolides?

Answer 14

digoxin toxicity

Question 15

What interaction is between Phenytoin and Septra?

Answer 15

Phenytoin toxicity

Question 16

What can benzodiazepines, TCA, antipsychotics put a patient at risk for?

Answer 16

Falls/fractures

Question 17

What can TCAs do to a patient with BPH?

Answer 17

Urinary frequency

Question 18

What risk is there from putting a heart patient or HTN patient on NSAIDs?

Answer 18

NSAIDs can increase fluid retention and overwork the heart

NSAIDs can also cause bleeding, ulcers

Question 19

Non adherence may be as high as ____%

Answer 19

50%

Question 20

What percent of older patients take OTC medication?

Answer 20

72%

Question 21

Name 5 drugs you should always be considering to discontinue

Answer 21

1. Bisphosphonatews
2. PPIs
3. Iron supplements
4. Antipsychotics
5. Antidepressants