Geriatrics Flashcards
What is the general trend shown by the NZ period of life tables? (2 points)
- Life expectancy at birth has increased
- Life expectancy is still lower for maori populations
What are some tips to prevent alzheimer’s and dementia? (3 points)
- Healthy diet, quality sleep, regular exercise
- Mental stimulation
- An active social life
What are the visual declines observed with ageing? (6 points)
- general acuity
- peripheral vision
- ability to see in low light levels
- ability to see highly reflective surfaces in bright light
- ability to discriminate between colours
- ability to adapt to darknes
What are the changes in the skin characteristics observed with ageing? (6 points)
- dry skin
- loss of elasticity (wrinkles)
- deletion and rearrangement of small blood vessels
- impaired wound healing
- decreased clearance into blood stream
- decreased absorption (?)
What are the signs of skin ageing? (3 points)
- collagen and elastin deecreases 1-2% per year
- ECM protein changes
- end result is saggy skin, development of rhytids and looking old
What is the trend between ageing and hepatic clearance? (2 points)
- hepatic clearance decreases as specific content of CYP450 enzymes in the liver diminishes
- Half life of drugs therefore increase
What are the changes to the oral cavity observed with ageing? (4 points)
- drier mucosa which is more susceptible to injury and a reduced capillary blood supply
- decreased bulk and tone of muscle which decreases masticatory efficiency
- decreased resting saliva secretion and enzyme activity of saliva as well as increased viscosity
- Deceased number of taste buds, increased dysfunction and cancer.
What dosage forms may cause problems to elderly patients? (6 points)
- chewable tablets
- sublingual and buccal tablets
- capsules
- liquid and suspensions
- transdermal delivery systems
- parenteral dosage forms and invasive devices
What are some suitable tablet dosage forms for elderly patients? (3 points)
- coated tablets are less likely to adhere to the oesophageal mucosa
- effervescent tablets form a clear solution which is suitable for patients with less gastric fluid production
- dispersion or soluble tablets which undergo a quick dissolution in the mouth or a glass of water
what are MDDDS?
mouth dissolving drug delivery systems
How are MDDDS different from conventional tablets? (4 points)
- tablet disintegrates/dissolves rapidly in saliva without the need for water or chewing before swallowing as a slurry or suspension
- new generation of formulations with combined advantages of liquid and conventional solid dosage forms
- provides convenience of a tablet formulation but does not require water
- allows ease of swallowing provided by a liquid formulation with more accurate dosing
what are MDDDS also known as? (3 points)
- fast disintegrating tablets
- fast dissolving tablets
- oral disintegrating tablets
How are mouth dissolving tablets (MDT) designed? (2 points)
- to dissolve in saliva remarkably fast within a few seconds and are true fast dissolving tablets
- others contain agents to enhance the rate of disintegration in the oral cavity (5-45s) and are better known as fast-disintegrating tablets
Who are MDTs suitable for? (2 points)
- geriatric, paediatric, travelling and psychotic patients
- patients with dysphagia which is associated with many conditions like PD, AD, stroke
What are the ideal properties of MDTs? (7 points)
- dissolves/disintegrates in the mouth within a few seconds
- allow sufficient drug loading
- compatible with taste masking and other excipients
- have a pleasing mouth feel
- leave minimal or no residue in the mouth
- exhibit low sensitivity to environmental conditions such as humidity and temperature
- be adaptable and amenable to existing processing and packaging machinery at low cost
How do MDTs work?
-fast dissolving property is attributed to quick ingress of water into the tablet matrix resulting in rapid disintegration
What are the technologies for formulating MDTs based on? (3 points)
- increasing porosity and/or
- addition of super-disintegrants
- use of water soluble excipients
Which technologies are utilised for the manufacturing of MDDDS? (3 points)
- lyophilisation, spray drying, nanoisation, sublimation, mass extrusion
- direct compression
- taste-masking
What are examples of MDDS technologies? (4 points)
- Feldene melt contains piroxicam 20mg, formulated by freeze drying
- Clarintin reditab contains loratidine 10mg formulated by freeze drying
- Tempra quicklets contains paracetamol 80mg formulated by effervescent direct compression
- zomig rapimelt contains zolmitriptan formulated by effervescent direct compression
What is tiltab? (3 points)
- irregular shape design which prevents it from lying flat
- tablets formulated like this are easier to handle by patients with impaired dexterity or dry mouth
- tablets are readily identifiable by elderly patients
What is intensol? (3 points)
- concentrated oral solution
- contains alprazolam concentrated solution
- inactive ingredients include PEG, succinic, succinic acid disodium salt and water
What are examples of other drugs formulated as intensols? (5 points)
- oxycodone and methadone
- dexamethasone
- prednisone
- diazepam and lorazepam
- metoclopramide
How should intensol be used? (5 points)
- it is much more concentrated compared to conventional oral solutions
- dose is measured using a calibrated dropper
- to be mixed with liquid or semi-solid fold (water, milk, juices, soups, cereals)
- easily and quickly miscible with most edible liquids and semisolids
- should be taken immediately and not stored for future use.
