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Pharmacology > Geriatrics > Flashcards

Geriatrics Flashcards

1
Q

Main challenges in elderly

A

multiple co-morbidities, polypharmacy, compliance, cost, new drugs

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2
Q

Leading causes of mortality

A

CVD, CA, respiratory

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3
Q

Leading causes of morbidity

A

arthritis, HTN, hearing loss, heart disease

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4
Q

Gastrointestinal changes w/ elderly

A

inc stomach pH, dec blood flow, slowed gastric emptying

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5
Q

Skin changes w/ aging

A

thinning of dermis, loss of SQ fat

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6
Q

Body composition changes w/ againg

A

decreased total body water, decreased lean body mass, body fat percentage changes

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7
Q

Liver changes w/ aging

A

dec liver mass, dec blood flow, dec or no change to CYP 450

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8
Q

Renal changes w/ aging

A

dec glomerular filtration rate, dec blood flow, dec tubular secretion, dec mass, dec functional nephrons

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9
Q

Absorption problems

A

rate of absorption decreased, little change in extent of absorption

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10
Q

Decreased body water causes

A

higher drug concentrations and affects hydrophilic drugs

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11
Q

Decreased lean body mass effects

A

lipid soluble drugs increased half-life

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12
Q

Decreased plasma protein effects

A

highly protein bound drugs increased free fractions

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13
Q

Effects of metabolism changes

A

reduction in first-pass metabolism, phase II metabolism is less affected by age

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14
Q

limitations in measuring CrCl

A

not everyone has decline in renal function, muscle mass reductions

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15
Q

Pharmacodynamic changes

A

reduced sensitivity to B-adrenergic stimulation, impaired baroreceptor reflex, more sensitive to antagonism of cholinergic receptors, CNS disorders, increased effects on some meds

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16
Q

CNS changes w/ aging

A

volume loss, slower processing, more activation required more simple tasks, dopaminergic decrease, serotonergic changes with depression, memory and cognition changes, sympathetic outflow increased

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17
Q

Drugs that affect bone and muscle integrity

A

glucocorticosteroids, PPIs, phenytoin

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18
Q

Drugs that affect balance

A

sedative hypnotics, antiHTN, long T1/2 or large dose benzos, TCAs, antipsychotics, anticonvulsants

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19
Q

Drugs that affect mental state

A

anticholinergics, benzos, pentazocine, muscle relaxants, TCAs, amitryptyline, antispasmodics, diphenhydramine, antihistamines

20
Q

Drugs that affect emotional state

A

methyldopa, reserpine, anastrozole, interferon a-2b, tamoxifen

21
Q

Drugs that affect continence

A

anticholinergics, a-blockers, a-agonists, alcohol, acetylcholinesterase inhibitors, diuretics

22
Q

Prescribing in the elderly

A

start w/ low dose, avoid starting multiple agents at same time, reach therapeutic dose before switching agents, consider non-pharm approaches

23
Q

Enhancing medication adherence

A

limit prescribing newer, expensive drugs, simplify regimen, pill organizers, educate pt on benefits, assess appropriateness of meds

24
Q

Causes of constipation

A

dietary, failure to heed reflex, impaired physical mobility, disease, age, drugs

25
Q

Drugs that cause constipation

A

analgesics, antacids, anticholinergics, antidepressants, verapamil, clonidine, iron

26
Q

Non-pharm treatment

A

fluid, fiber, fitness

27
Q

Bulk laxatives

A

psyllium (Metamucil), Methylcellulose (Citrucel), Polycarbophil (Fibercon) -1250 mg PO 1-4/day

28
Q

MOA of bulk laxatives

A

increase bulk volume and water content of stool, stimulating peristalsis and decrease colonic transit time; 12-72 hr onset

29
Q

Pearls of bulk laxatives

A

must have adequate fluid intake, not good for bed ridden pts or opioid induced, great for chronic management, as good as stool softener

30
Q

Surfactant/emollient

A

Docusate (Colace)- 100 mg PO BID

31
Q

MOA of surfacant/emollient

A

decrease fecal surface tension, stool softener

32
Q

Pearl of surfacant/emollient

A

onset- 24-72 hr, mostly PO, sometimes enema, combo (senna- Peri- colace), very safe, OTC

33
Q

Saline laxatives (Cathartics)

A

magnesium citrate (300 ml), Magnesium hydroxide (MOM, 30 ml), sodium bi/phosphate (Fleets phospho-soda), fleets enema

34
Q

MOA of saline laxatives

A

draws fluid into colon and stimulates activity

35
Q

pearls of saline laxatives

A

onset- 30min-3 hr, great for acute, avoid in pt w/renal disease, citrate and fleets used for prep (green bullet)

36
Q

Hyperosmotics

A

glycerin- infants, lactulose (Chronulac)- chronic, liver failure, polyethylene glycol (Miralax), polyethylene glycol-electrolyte solution (GoLytely)

37
Q

Stimulants

A

bisacodyl (Ducolax)- 5-15 mg po, Senna (senokot), castor oil

38
Q

MOA of stimulants

A

irritates nerves in colon, stimulates motility

39
Q

Bisacodyl mostly used

A

for short term, once daily if chronic, OTC, also prep

40
Q

Senna used for

A

opioid induced constipation, OTC

41
Q

Lubricants

A

mineral oil, lubricates intenstine, decreases water absorption, onset 6-8 hrs, not used often

42
Q

Laxative ADRs

A

abd cramping, bloating, flatulence, distension, diarrhea, saline lxatives can cause diuresis, dehydration, electrolyte imbalances, bulk lax can cause GI obstruction

43
Q

General treatment guideline for constipation

A

first bulk-forming, surfactant/emollient or lubricant, saline cathartic, hyperosmotic agent, then stimulant

44
Q

Special populations

A

elderly-docusate, lactulose, fiber, pregnancy-fiber, children- glycerin suppositories, polyethylene glycol, diabetics- metoclopramide, stimulant, post op- MOM, maybe stimulant

45
Q

Restless leg syndrome non-pharm

A

avoid EtOH, tobacco, Fe, avoid drugs that alter serotonin, follow regular sleep patterns, exercise, avoid prolonged sedentary activities, stretch, massage leg

46
Q

RLS pharm approach

A

dopaminergic agents, give before bed, levodopa/carbidopa- may be best option, dopamine agonists (Pramipexole (Mirapex), Ropinirole (requip)), sedatives, hypnotics, anticonvulsants, opioids

Pharmacology (61 decks)

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