Geriatrics Flashcards
How is gastric pH affected in geriatric patients?
Gastric pH may rise changing ionization
How is passive absorption affected in geriatric patients?
Complete but slower
Increased by longer GI transit time
increase in epithelial permeability
Reduced perfusion
What are some changes in the distribution of drugs in geriatric patients?
Increase in membrane permeability and passive transport
Tissue perfusion may decrease with age
Dysfunction of blood-brain barrier may change volume of distribution
How much is hepatic flow reduced in older patients?
Hepatic blood flow reduced 30 to 50%
How is protein binding affected in older patients?
Decreased albumin, increased alpha1- acid glycoprotein
What type of drugs does albumin bind?
Acidic and neutral
What type of drugs does alpha1- acid glycoprotein bind?
Basic
A 80 year Patient with decreased albumin needs an acidic drug, do you decrease or increase the does?
Decrease
What Phase of drug metabolism is decreased in older patients?
Phase I
What Phase of drug metabolism is preserved in older patients?
Phase II
How is the GFR affected in elderly patients?
Decreased 15 to 40% and effective renal plasma flow reduction of about 10% per decade of life from young adulthood to age 80
An elderly patient comes in with a decreased creatinine clearance. What might you need to adjust to maintain steady state?
Dosing intervals
In the elderly drugs will take ______ to reach steady state
longer
In the elderly it will take _______ for drugs to be eliminated after discontinuation
longer
A decrease in creatinine clearance will mean an increase in _________?
half -life
An increase in ____________ will mean an increase in half-life
volume of distribution
T or F - in the elderly there is a reduction in cardiac and vascular beta-adrenergic responsiveness.
How does this affect the beta blocking effects of drugs?
True - Less sensitive to beta blocking effects of drugs
In regards to the CNS, are agents generally more or less effective in elderly patients?
Less effective - and adverse reactions are greater
How are the frail elderly characterized?
High susceptibility to disease
Impending decline in physical function
High risk of death
Measured through
- Mobility (walk time)
- Strength (grip strength)
- Nutrition (weight loss)
- Endurance (exhaustion)
- Physical activity
The frail elderly have increased rates of ADR’s with significant morbidity and mortality due to?
Less physiologic reserve
Polypharmacy
Adherence issues related to cognitive and sensory impairment
Frequent admissions to the hospital because of increased susceptibility to disease
What is medication reconciliation?
going through a patients drugs and removing uneeded ones
When reconciling medication what are some appropriate questions to ask?
- Is there an indication for the drug?
- Is the medication effective for the condition?
- Is the dosage correct?
- Are the directions correct?
- Are the directions practical?
- Are there clinically significant drug-drug interactions?
- Are there clinically significant drug-disease interactions?
- Is there unnecessary duplication with other drugs?
- Is the duration of therapy acceptable?
- Is this drug the least expensive alternative compared with others of equal usefulness?
What is the PIM (Beers) list?
potentially inappropriate medications - Follows evidence-based approach of the Institute of Medicine
What are the two categories of PIM?
Medications to avoid regardless of diseases or conditions
Medications considered potentially inappropriate when used with certain diseases or conditions
- A third group, medications that should be used with caution
