Geriatrics - Introduction & PKPD Flashcards
How is the cardiovascular system different in elderly ?
decreased contraction/filling capacity/efficiency, increased stiffness of vasculature
How is the central nervous system different in elderly ?
decreased rate of conduction/strength of transmission, arousal threshold blurred
How is the respiratory system different in elderly?
normal at rest, compromised under stressed via decreased anatomical expiration/elasticity/ventilation
How is the genitourinary system different in elderly?
decreased ability to concentrate urine/renal blood flow/acid-base adaptation/secretions, atrophy of reproductive system in women, decrease in libido/sexual function
How is the gastrointestinal system different in elderly?
decreased nutrition (poor dentition), decreased motility/acid production/secretions/liver size and blood flow/metabolism
How is the musculoskeletal system different in elderly?
decreased structure and function, erosion/degeneration/calcification resulting in fractures/falls/kyphosis
How is the dermatological system different in elderly?
decreased elasticity/turgor, increased pigmentation
List the geriatric symptoms?
dementia, delirium, urinary incontinence, falls, gait disturbances, dizziness, syncope, hearing/visual impairment, osteopenia, malnutrition, eating and feeding problems, pressure ulcers, sleep problems
List the “other” geriatric symptoms?
polypharmacy, self-neglect, frailty, elder abuse, hypo/hyperthermia, dehydration and electrolyte imbalance, iatrogenesis
Define frailty?
a state of vulnerability to poor resolution of homeostasis after a stressor event as a consequence of cumulative lifetime decline
What does the iatrogenic cascade refer to?
prescribing for prescriptions
What are the geriatric 5Ms?
mind, mobility, medications, multi-complexity, matters most
What are the geriatric 3Hs?
happy, healthy, at home
Palliative care is more for _____, whereas curative care is more ______?
relief, preventative
What is the net effect of oral absorption changes in elderly?
no significant effect on rate or extent of absorption
What is the net effect of transdermal absorption changes in elderly?
decreased absorption of hydrophilic compounds (dryer skin)
What is the net effect of mucosal absorption changes in elderly?
no significant change
What is the net effect of plasma protein concentration changes in elderly?
no significant change (in healthy persons)
How is CYP3A4 metabolism affected in elderly? CYP2D6?
decreased; no significant change
Which phase of metabolism is decreased in elderly?
Phase I
How is enzyme induction affected in elderly? Inhibition?
possible decrease; no significant change
How is gastrointestinal absorption affected in elderly?
unchanged passive diffusion and no change in bioavailability, decreased active transport/first-pass metabolism
How is drug distribution affected in elderly?
decreased Vd and increased Cp for hydrophilic drugs, increased t1/2 for hydrophobic drugs
How is renal excretion affected in elderly?
decreased clearance and increased t1/2 for renally eliminated drugs
Explain a baseline versus a sensitivity difference in elderly?
baseline = different start point (y-intercept), sensitivity = different slope
How is cardiovagal tone affected in elderly?
decreased b-adrenergic response (agonist and antagonist)
How is the BBB affected in elderly?
increased permeability (P-gp reduction)
