Geriatrics - Introduction & PKPD

Question 1

How is the cardiovascular system different in elderly ?

Answer 1

decreased contraction/filling capacity/efficiency, increased stiffness of vasculature

Question 2

How is the central nervous system different in elderly ?

Answer 2

decreased rate of conduction/strength of transmission, arousal threshold blurred

Question 3

How is the respiratory system different in elderly?

Answer 3

normal at rest, compromised under stressed via decreased anatomical expiration/elasticity/ventilation

Question 4

How is the genitourinary system different in elderly?

Answer 4

decreased ability to concentrate urine/renal blood flow/acid-base adaptation/secretions, atrophy of reproductive system in women, decrease in libido/sexual function

Question 5

How is the gastrointestinal system different in elderly?

Answer 5

decreased nutrition (poor dentition), decreased motility/acid production/secretions/liver size and blood flow/metabolism

Question 6

How is the musculoskeletal system different in elderly?

Answer 6

decreased structure and function, erosion/degeneration/calcification resulting in fractures/falls/kyphosis

Question 7

How is the dermatological system different in elderly?

Answer 7

decreased elasticity/turgor, increased pigmentation

Question 8

List the geriatric symptoms?

Answer 8

dementia, delirium, urinary incontinence, falls, gait disturbances, dizziness, syncope, hearing/visual impairment, osteopenia, malnutrition, eating and feeding problems, pressure ulcers, sleep problems

Question 9

List the “other” geriatric symptoms?

Answer 9

polypharmacy, self-neglect, frailty, elder abuse, hypo/hyperthermia, dehydration and electrolyte imbalance, iatrogenesis

Question 10

Define frailty?

Answer 10

a state of vulnerability to poor resolution of homeostasis after a stressor event as a consequence of cumulative lifetime decline

Question 11

What does the iatrogenic cascade refer to?

Answer 11

prescribing for prescriptions

Question 12

What are the geriatric 5Ms?

Answer 12

mind, mobility, medications, multi-complexity, matters most

Question 13

What are the geriatric 3Hs?

Answer 13

happy, healthy, at home

Question 14

Palliative care is more for _____, whereas curative care is more ______?

Answer 14

relief, preventative

Question 15

What is the net effect of oral absorption changes in elderly?

Answer 15

no significant effect on rate or extent of absorption

Question 16

What is the net effect of transdermal absorption changes in elderly?

Answer 16

decreased absorption of hydrophilic compounds (dryer skin)

Question 17

What is the net effect of mucosal absorption changes in elderly?

Answer 17

no significant change

Question 18

What is the net effect of plasma protein concentration changes in elderly?

Answer 18

no significant change (in healthy persons)

Question 19

How is CYP3A4 metabolism affected in elderly? CYP2D6?

Answer 19

decreased; no significant change

Question 20

Which phase of metabolism is decreased in elderly?

Answer 20

Phase I

Question 21

How is enzyme induction affected in elderly? Inhibition?

Answer 21

possible decrease; no significant change

Question 22

How is gastrointestinal absorption affected in elderly?

Answer 22

unchanged passive diffusion and no change in bioavailability, decreased active transport/first-pass metabolism

Question 23

How is drug distribution affected in elderly?

Answer 23

decreased Vd and increased Cp for hydrophilic drugs, increased t1/2 for hydrophobic drugs

Question 24

How is renal excretion affected in elderly?

Answer 24

decreased clearance and increased t1/2 for renally eliminated drugs

Question 25

Explain a baseline versus a sensitivity difference in elderly?

Answer 25

baseline = different start point (y-intercept), sensitivity = different slope

Question 26

How is cardiovagal tone affected in elderly?

Answer 26

decreased b-adrenergic response (agonist and antagonist)

Question 27

How is the BBB affected in elderly?

Answer 27

increased permeability (P-gp reduction)