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Pharm Exam 5 > Geriatrics Pharm > Flashcards

Geriatrics Pharm Flashcards

1
Q

Preventing prescribing cascade:

A
  • avoid prescribing until results confirm suspected diagnosis
  • start with low dose and titrate slowly
  • when possible, avoid starting multiple meds simultaneously
  • reach therapeutic dose before swithing or adding agents
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2
Q

Pysiological change with aging - Body composition:

A
  • dec total body water
  • dec lean body mass
  • inc body fat
  • same or dec serum albumin
  • inc alpha1 acid glycoprotein
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3
Q

Pysiological change with aging- cardiovascular

A
  • dec myocardial sensitivity to beta-adrenergic stimulation
  • dec baroreceptor activity
  • dec cardiac output
  • inc total preiph resistance
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4
Q

Pysiological change with aging - liver

A
  • dec hepatic size
  • dec hepatic blood flow
  • dec activity of Phase 1 enzymes (p450s)
  • PHase 2 is NORMAL
  • clearance of a drug is decreased
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5
Q

Pysiological change with aging - renal

A
  • dec GFR
  • dec RBF
  • dec filtration fraction
  • dec tubular secretory function
  • dec renal mass
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6
Q

What parameter of pharmacokinetics is least effected by aging?

A

absorption/bioavailability

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7
Q

What are drugs that have decreased absorption bc of dec stomach acidity?

A
  • digitalis

- ampicillin

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8
Q

Highly lipophilic drugs - what happens to volume of distribution?

A

-huge dec INC? in volume of distribution - most drug wll bind to lipid

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9
Q

Higher concentration drug in the plasma - relationship to distribution in the blood?

A

lower Vdistribution bc its not in the tissues

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10
Q

Plasma binding factor

  • effect on Vd
  • age related changes?
A
  • hgihly protein bound = cant distribute to tissues = smaller Vd
  • dec ablumin=binds acidic drugs
  • inc alpha1 glycoprotein binds to basic drugs
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11
Q

Tissue binding properties

  • effect on Vd
  • age related changes?
A
  • tightly bind tissues = higher Vd
  • dec lean body mass
  • inc adiposity
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12
Q
  • Digoxin and Vd in elderly?

- how to fix dosing?

A
  • Digoxin likes to bind muscle –> so less muscle in elderly = inc active fraction in circulation
  • need to give lower dose
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13
Q

Lipid to water coefficient

  • effect on Vd
  • age related changes?
A
  • lipid soluble drugs like to pass through lipid membranes so they like to enter tisses more = larger Vd
  • water soluble have lower Vd
  • inc in body fat–>Inc Vd for lipid soluble
  • dec body water–>dec Vd for water soluble
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14
Q

How to give loading dose of water soluble drugs in elderly

A

-must decrease loading dose to avoid toxicity from high initial concentration

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15
Q

Clearance of a drug and flow rate limited phase 1 eliminated drugs?
Dosing?

A
  • clearance will be decreased

- dosing will need to be decreased

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16
Q

Clearance of a drug and liver enzyme function (capacity limited) drugs?
-Dosing changes for phase 1 and 2 eliminated?

A
  • No change in clearance or dosnig if phase 2 metabolized drug
  • dec clearance and dosing if metabolized by phase 1 drugs
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17
Q

How to dose drugs with a narrow therapeutic index (warfarin and gentamycin) in elderly with dec kidney function

A

must use the cockcroft gault (measure of creatiniine clearance) equation bc there is individual variability.

18
Q

What is a more accurate measure of creatinine clearange?

A

-use direct creatinine clearance measurement - need 24 hr urine collection and not cockcroft gault equation

19
Q

CALCULATE halflife of a drug?

A

t.5=.693XVd/CL

20
Q

two factors that have greatest effect on the halflife of a drug?

A

decreased hepatic and renal function

21
Q

GI issue with aging+drug?

A
  • decreased acid = dec absoption of some drugs
  • dec first pass extraction and inc bioavailability for some drugs
  • no change in most drugs
22
Q

Distribution issue with aging +drug?

A
  • dec Vd and inc plasma concentration for water sol drgs
  • inc Vd and inc terminal deposition halflife for fat soluble drugs
  • inc or dec free fraction of highly plasma protein bound drugs
23
Q

Hepatic metabolism issue with aging+drug?

A
  • dec clearance and inc t.5 for some oxidatively metabolized drugs (Phase 1 metabolism)
  • dec clearance and inc t.5 for drugs that are flow limited
24
Q

Renal excretion issue with aging + drug?

A

-dec clearance and inc t.5 for renally eliminated drugs and active metabolites

25
Q

Pharmacodynamic changes with which receptor type?

A

-beta adrentegic only - dec respones (Alpha response is same)

26
Q

elderly inc in toxicity to NSAIDS how?

A
  • Gi bleeding and irritation
  • renal damage: local renal production of prostaglandins low in normal young people –> when RBF decreases there is inc prostaglandin production to inc RBF and maintain GFR
27
Q

Adverse effects of anticholinergic drgus?

A

-serious bizz – many. try to stay away from anticholinergic drugs and elderly people

28
Q

*Do not use: Antidepressant with strong/moderate anticholinergic properties- name the drugs:

A

STRONG:
amytriptyline
despiramine
doxepin

MODERATE:
-paroxetine

29
Q

Do not use: Anticonvulsants that have MODERATE anticholinergic properties:

A

-carbamazepine

30
Q

Do not use: Antihistamines that have STRONG anticholinergic properties:

A
  • Chlorpheniramine
  • diphenhydramine
  • hydroxyzine
31
Q

Do not use: Antipsychotics that have STRONG/MODERATE anticholinergic properties:

A

STRONG:

  • clozapine
  • thioridazine

MODERATE:

  • Loxapine
  • pimozide
  • olanzapine
  • quietapine
32
Q

Do not use: Cardiovascular that have MODERATE anticholinergic properties:

A

-disopyramide

33
Q

Do not use: GI anti-spasmodics that have STRONG anticholinergic properties:

A

-dicyclomine

34
Q

Do not use: H2 antagonists that have MODERATE anticholinergic properties:

A

cimetidine

ranitidine

35
Q

Do not use: muscle relaxants that have STRONG/MODERATE anticholinergic properties:

A

Strong:
-orphenadrine

MoD;
-cyclobenzaprine

36
Q

Do not use: Parkinsonian drugs that have STRONG anticholinergic properties:

A
  • benzotropine

- trihexyphenidyl

37
Q

Do not use: Urinary antispasmodics that have STRONG anticholinergic properties:

A

oxybutynin

tolterodine

38
Q

Do not use: Vertigo drugs that have STRONG anticholinergic properties:

A

-dimenhydrinate
-meclizine
scopolamine

39
Q

High risk drugs types and why not to use in elderly

A
  • NSAIDS - many issues
  • anticoags- aging inc sensitivity
  • antidepressants-inc risk for drug interactions
40
Q

Which anti-hyperglycemic should be used in the elderly? WHY?

A
  • glipizide - short acting

- risk of hypoglycemia goes up with other glucose mod drugs

41
Q

Issue with digoxin use in elderly?

A

Inc risk of toxicity

  • renal impairment
  • temporary dehydration
  • NSAID use has synergistic effects= risk

Pharm Exam 5 (10 decks)

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