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PHARM 303 > Geriatrics > Flashcards

Geriatrics Flashcards

1
Q

PK Changes - Absorption
- Gastric pH

A

Decreased gastric acid production with age
- Increases pH

Less release of oral dosages
Low permeability of acidic drugs (Gets ionized in high pH)

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2
Q

PK Changes - Absorption
- Gastric Emptying

A

Decreases gastric emptying
- Longer transit time

High change of local irritation
Increased absorption of drugs

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3
Q

PK Changes - Absorption
- Blood flow

A

Decreased blood flow to organs
- Decreased hepatic clearance

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4
Q

PK Changes - Absorption
- Absorption Surfaces in GI

A

Decreased absorption surface in GI tract
- Decreased absorption and bioavailability

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5
Q

PK Changes - Distribution
- Albumin

A

Older than 80 = Decreased plasma albumin
- Decreased binding of acidic drugs
- Increased free fraction

Decreases Total Concentration
No effect on Free Concentration

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6
Q

PK Changes - Distribution
- Alpha-1-acid glycoprotein

A

Increased alpha-1-acid glycoprotein
- Increased binding of basic drugs
- Decreased free fraction

Increases Total Concentration
No effect on Free Concentration

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7
Q

PK Changes - Distribution
- Total Body Water

A

Decrease in Total Body Water

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8
Q

PK Changes - Distribution
- Total Body Fat

A

Increase in Total Body Fat
- Increases Vd of Fat Soluble Drugs

Fat soluble drugs accumulate and can lead to adverse effect
- Benzodiazepines

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9
Q

PK Changes - Elimination
- High E Given IV

A

Clearance depends on Hepatic Blood Flow
- Beta Blockers and Morphine

Decrease in Hepatic Blood Flow leads to Decrease in Metabolism leads to Increased Exposure

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10
Q

PK Changes - Elimination
- High E Given PO

A

Clearance depends on Intrinsic Clearance and Free Fraction
- Phase I have lowered activity
- Phase II are preserved

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11
Q

PK Changes - Elimination
- Low E

A

Clearance depends on Intrinsic Clearance and Free Fraction
- Phase I have lowered activity
- Phase II are preserved

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12
Q

What drugs to avoid in Elderly

A

Benzodiazepines and Tricyclic Antidepressants
- Are fat soluble and will accumulate leading to adverse effects

Use Lorazepam or Oxazepam instead

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13
Q

How to determine if a drug is Low E or High E

A

Compare IV and Oral dosing
- If IV and Oral dose is similar = Low E
- If IV is significantly lower than Oral = High E

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14
Q

Low E Drug / High E Drug given PO
- Dose Rate / Free Fraction / Intrinsic Clearance

A

Clearance depends on Intrinsic and Free Fraction

Dose: Proportional
Free Fraction
- Total: Inverse
- Free: No effect
Intrinsic: Inverse

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15
Q

High E Drug given IV
- Dose Rate / Free Fraction / Intrinsic Clearance

A

Clearance depends on hepatic blood flow

Dose: Proportional
Free Fraction:
- Total: No effect
- Free: Proportional
Intrinsic: No effect

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16
Q

PK Changes - Elimination
- Renal Function

A

Decreased renal function = decreased drug clearance

17
Q

Serum Creatinine as a marker

A

Not ideal, is influenced by muscle mass

18
Q

Blood Urea Nitrogen as a marker

A

Not ideal, is influenced by fluid balance and nutrition

19
Q

Creatinine Clearance as a marker

A

Ideal marker
- Is glomerular filtration + tubular secretion

20
Q

When to consider dose adjustment
- Renal Drugs

A
  • Drug is cleared renally
  • Creatinine Clearance decreases by 50%
21
Q

Guidelines for Elderly

A

Beers Criteria
- List of potentially inappropriate drugs for elderly

22
Q

PD Changes in Elderly
- Acetylcholine

A

Decreased effects
- Drugs that block will be more effective (Antiparkinsons)
- Drugs that stimulate will be less effective

23
Q

PD Changes in Elderly
- Dopamine

A

Decreased effects
- Drugs that block will be more effective (Antiparkinsons)
- Drugs that stimulate will be less effective

24
Q

PD Changes in Elderly
- MAO

A

Increased effects

25
Q

PD Changes in Elderly
- Beta Adrenergic

A

Receptors have decreased binding affinity

26
Q

PD Changes in Elderly
- Warfarin

A

Increased response

27
Q

PD Changes in Elderly
- Insulin

A

Increased sensitivity

28
Q

PD Changes in Elderly
- Theophylline

A

Direction of change between Desired effects and adverse effects is not the same
- Increased inotropic effects
- Decreased bronchodilator effects

29
Q

PD Changes in Elderly
- Verampril

A

Direction of change for PK and PD effects are not the same
- Increased concentration
- Decreased effect

PHARM 303 (10 decks)

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