Geriatric Pharmacology

Question 1

Young Adults vs Older Adults: Body water (% of body weight)

Answer 1

Older Adults are composed of less water

Question 2

Young Adults vs Older Adults: Lean body mass (% of body weight)

Answer 2

Older Adults are composed of less lean body mass

Question 3

Young Adults vs Older Adults: Body fat

Answer 3

Older Adults are more body fat

Question 4

Young Adults vs Older Adults: Serum albumin

Answer 4

Older Adults have less albumin

Question 5

Young Adults vs Older Adults: Kidney weight

Answer 5

Older Adults have smaller kidneys

Question 6

Young Adults vs Older Adults: Hepatic blood flow

Answer 6

Older Adults have less blood flow to the liver

Question 7

Absorption - age may not be an independent factor; however

Answer 7

the conditions associated with aging may be (healthy 80 year old vs unhealthy 60 year old)

Question 8

Old people: consideration for Absorption

Answer 8

Use of antacids, laxatives, chronic constipation, and diarrhea influence gastric emptying

Question 9

Old people: consideration for Distribution

Answer 9

The composition of the aging body may influence serum proteins, volume of distribution and clearance of drugs.

Question 10

Old people: consideration for Metabolism - aging correlates more with the liver’s ability to metabolize drugs in the Phase

Answer 10

I reactions (P450) than Phase II (conjugation) reactions.

Question 11

Old people: consideration for Metabolism: Decreased b____

Answer 11

Decreased blood flow to liver

Question 12

Old people: consideration for Metabolism: Decreased a____

Answer 12

Decreased ability of liver to recover from injury (alcohol or viral hepatitis)

Question 13

Old people: consideration for Metabolism: _____ diseases (heart failure)

Answer 13

Concomitant

Question 14

Old people: consideration for Metabolism: Severe

Answer 14

malnutrition

Question 15

Old people: consideration for Elimination: a decline in

Answer 15

creatinine clearance. Accumulation of drug can potentially lead to toxicity.

Question 16

Old people: consideration for CNS Drugs

Answer 16

Sedative-hypnotics: t ½ of denzodiazepines (BDZ) and barbiturates may increase → increased toxicities that may cause ataxia and other stability impairments → increased falls and fractures

Question 17

Old people: consideration for CNS Drugs: Sedative-hypnotics: t ½ of denzodiazepines (BDZ) and barbiturates may increase →

Answer 17

increased toxicities that may cause ataxia and other stability impairments → increased falls and fractures

Question 18

Old people: consideration for CNS Drugs: Sedative-hypnotics: t ½ of denzodiazepines (BDZ) and barbiturates may increase → increased toxicities that may cause ataxia and other stability impairments → increased falls and fractures. What might be drugs that have lower risks?

Answer 18

lorazepam and oxazepam may offer lower risks

Question 19

Old people: consideration for CNS Drugs: Opioid analgesics:

Answer 19

increased sensitivity to these agents may produce respiratory depression with lower doses.

Question 20

Old people: consideration for CNS Drugs: Antipsychotics and Antidepressants: Higher sedative and muscarinic effects

Answer 20

may contribute to memory impairments and intellectual dysfunction

Question 21

Old people: consideration for CNS Drugs: Antipsychotics: 
E
A
t
P
B
TD

Answer 21

Extrapyramidal toxicity-dystonia
akathisia
tremor
parkinsonism
bradykinesia
tardive dyskinesia

Question 22

Old people: consideration for CNS Drugs: Antipsychotics and Antidepressants: Increased a-adrenoceptor blockade will cause

Answer 22

higher incidences of orthostatic hypotension (older drugs, chlorpromazine)

Question 23

Old people: consideration for CNS Drugs: Antipsychotics and Antidepressants: Antidepressants may have higher rates of

Answer 23

adverse drug reactions

Question 24

akathisia

Answer 24

restless

Question 25

Extrapyramidal toxicity-dystonia

Answer 25

muscle movements

Question 26

tardive dyskinesia

Answer 26

repetitive, involuntary movements

Question 27

Old people: consideration for Cardiovascular Drugs: Antihypertensives precaution should be taken with

Answer 27

thiazides when comorbidities are present.

Question 28

Old people: consideration for Cardiovascular Drugs: Antihypertensives: diabetic

Answer 28

hyperglycemia in a diabetic

Question 29

Old people: consideration for Cardiovascular Drugs: Antihypertensives: gout

Answer 29

hyperuricemia in gout

Question 30

Old people: consideration for Cardiovascular Drugs: Antihypertensives: COPD

Answer 30

b-blockers in COPD

Question 31

Old people: consideration for Cardiovascular Drugs: Antihypertensives: Hypokalemia and arrhythmias

Answer 31

?

Question 32

Old people: Antimicrobial Agents: Since most antimicrobials are renally cleared,

Answer 32

dosing is important

Question 33

Old people: Antimicrobial Agents: Renal function should be carefully monitored when using

Answer 33

aminoglycosides, vancomycin, and polymyxin.

Question 34

Old people: Antimicrobial Agents: ___ ___ should be carefully monitored when using aminoglycosides, vancomycin, and polymyxin.

Answer 34

Renal function

Question 35

Old people: Anti-inflammatory Agents: Aspirin

Answer 35

GI bleeds and GI irritation

Question 36

Old people: Anti-inflammatory Agents: NSAIDs

Answer 36

may cause irreversible renal damage

Question 37

Antacids increase gastric pH. Result is decreased GI absorption of d___, k___, q___ a___, t___

Answer 37

digoxin, ketoconazole, quinolone antibiotics and tetracyclines

Question 38

Sulfonamides

Answer 38

can displace Methotrexate, phenytoin, and warfarin from their binding sites on albumin-> the result is higher concentrations of these drugs in plasma-> possible toxicity

Question 39

Sulfonamides can displace m___, p___, and w___ from their binding sites on albumin

Answer 39

Methotrexate, phenytoin, and warfarin

Question 40

Sulfonamides can displace Methotrexate, phenytoin, and warfarin from their binding sites on albumin-> the result is

Answer 40

higher concentrations of these drugs in plasma-> possible toxicity

Question 41

``` Examples of inducers b r c p s ```

Answer 41

Barbiturates, rifampin, carbamazepine, phenytoin, St. John’s wort

Question 42

``` Examples of inhibitors a d e g r ```

Answer 42

Amiodarone, disulfiram, erythromycin, furanocoumarins (in grapefruit juice), ritonavir

Question 43

Renal function naturally declines with age. Beta blockers can

Answer 43

Beta blockers can reduce renal blood flow and slow excretion of drugs