geriatrics meds Flashcards
what is the BEERS list?
list of medications likely to cause adverse effects in elderly
screening tool of older persons potentially inappropriate prescriptions
STOPP
screening tool to alert doctors to right treatment
START
as we age, there is a ______total body water
decrease
as we age, there is a ______lean body mass
decrease
as we age, there is a ______body fat
increase
as we age, there is a ______myocardial sensitivity to beta-adrenergic stimulation
decrease
as we age, there is a ______baroreceptor activity
decrease
as we age, there is a ______cardiac output
decrease
as we age, there is a ______total peripheral resistance
increase
what parameter is least affected by aging?
absorption
Fraction of drug reaching the systemic circulation.
bioavailability (F)
what is the volume of distribution?
amount of drug in body/plasma drug concentration
Would a highly water soluble drug have an increased or decreased t1/2 in an elderly patient when compared to a younger patient?
less of an increase in 1/2 life than lipid soluble drugs
Would the loading dose of a highly water soluble drug be larger or smaller in an elderly patient when compared to a young patient?
smaller
do lipid soluble or water soluble drugs have better volume of distribution?
lipid soluble drugs
effect of aging on fat soluble drugs?
longer half life
what does hepatic clearance rely on?
flow rate to organ x extraction ratio
does aging affect phase I enzymes of liver?
yes, reduces activity of cytochrome p450
does aging affect phase II enzymes of liver?
NO
effects of aging on liver
- decreased blood flow
2. reduced phase 1 enzymes
what is a capacity limited drug?
a drug whose hepatic clearance rate is affected by phase 1 liver enzyme fxn (not flow)
what is a flow rate limited drug?
a drug whose rate limiting hepatic clearance step is flow rate
how does aging issues with hepatic clearance affect drug dosing?
decrease in maintenance dose req’d
what is an index of glomerular filtration rate (GFR)
creatinine clearance
why is the cockcroft and gault eqn used?
to acct for the decr muscle mass in elderly patients
do hydrophilic or lipophilic drugs have a greater increase in half life in elderly?
lipophilic b/c greater volume of distribution
how does rxn to anesthetics change in elderly?
incr sensitivity to anesthetic agents
how is the response to CCB altered in elderly?
acute bp response is exaggerated; reduced baroreflex activation with aging
elderly have _____local renal production of PG?
increased
how do NSAIDS adversely affect elderly?
can diminish the PG that aids in renal blood flow and GFR
orthostatic hypotension, sedation,& blurry vision + the dry picture
AE of anticholinergic drugs that are esp pronounced in elderly
what classes of drugs have high anticholinergic activity?
• Anticonvulsants, antidepressants, antihistamines, antipsychotics, CV, GI antispasmodics, H2 antagonists, muscle relaxants, PD, urinary antispasmodics, vertigo drugs
