Gero Flashcards
gero physiologic changes
less lean body mass, inc body fat
loss of skeletal bone mass
atrophy of the thyroid gland
decrease in cell mediated immunity
reduction in cardiac output with activity
dec. lung tissue elasticity and strength of resp muscles
dec in renal blood flow and GFR
dec in GI motility and acid production
hepatic blood flow and liver mass are reduced
changes in sensory: vision, hearing, taste, thirst
gero metabolism changes
dec. first pass metabolism, minor changes in phase I metabolism, unchanged phase II metabolism
net effect - inc bioavail of drugs with ext. first pass metabolism and inc half life of drugs that are metabolized by phase I
no longer metabolising in GI tract (less enzyme) therefore high toxicity and levels
PK absorption changes
dec. gatric acidity, motility.
net effect- bioavailability of most drugs are not altered
PK changes in distribution
dec total body water, lean body mass, plasma albumin, inc adipose tissue
net effect - inc in serum conc of hydrophilic drugs anddrugs that distribute to lean body mass
dec protein binding will leat to inc in free drug
delay clearance of lipophillic drugs
PK elimination changes
dec renal blood flow and GFR
net effect - inc half life of drugs with predominant renal elimination
PD changes - less sensitive to/ more sensitive to
less sensitive to: beta receptors, baroreceptors, insulin receptors
more sensitive to: centrally acting drugs (narcotics, neuroleptics, antidepressants, benzodiazepines)
high risk meds with QTc interval prolongation
amiodarone, quinolones, macrolides, haloperidol (IV), ziprasidone, TCAs, antihistaines, methadone
high risk drugs with narrow therapeutic index
lithium, warfarin, digoxin
high risk drugs with anticholinergic effects
GI antispasmotics, GU drugs, Parkinson’s drugs, TCAs, trazodone, loperamide, antipsychotics, bronchodilators, atropeine
r/f confusion, urinary retention, dry mouth
high risk meds that are sedating
anticonvulsants, atypical antipsychotics, benzodiazepines, muscle relaxants, opioids, fluoxetine, TCA
high risk meds for hypoglycemia
insulin, sulfonylureas, TZD (pioglitazone/rosiglitazone) metformin (r/f lactic acidosis)
insulin eliminated by metabolization in kidneys, requirement goes down
adverse drug events, ER visits d/t meds
warfarin, insulin, digoxin, antiplatelets, oral hypoglycemics, narcotics, antibiotics
top drug-drug interactions
warfin/other anticoag and NSAID warfarin and TMP/SMZ (bleeding) ACE i - K supplement ACE i and sprionolactone ACEi and TMP/SMZ Warfarin and Cipro Digoxin and Amiodarone - av block, asystole, heart block, dig toxicity, same as verapamil DIgoxin and verapamil - rash and hyperkalemia Thyroid and Iron (or cipro)-chelating SSRI and tramadol HMG-CoA reductase inhibitor, gemfibrozil and erythromycin or itraconazole (myositis, rhabdo)
food-drug/ nutrient interactions
phentoin - dec folate
metformin - dec Vit B12
isoniazid - dec. Vit B6
phenytoin - dec absorption with NG feedings
levodopa - high protein meals effect blood-brain transport
Catopril - altered taste sensation
renal insufficiency (eGFR)
normal 90-150 decreased 60-90 mild 3015-60 moderate 15-30 uremia/severe renal failure <
