LC - Principles in Geriatric & Pediatric Pharmacology

Question 1

born before 37 weeks gestational age

Answer 1

Premature:

Question 2

: 1 day-1 month old

Answer 2

Neonate

Question 3

Infant age

Answer 3

1 mo- 1 year

Question 4

Geriatric age

Answer 4

> 65

Question 5

inefficient _____________ leads to accumulation –> shock (Grey Baby syndrome)

Answer 5

chloramphenicol glucuronidation

Question 6

CYP 450 Inducer

Answer 6

Chronic alcohol use
St. John’s wort
Phenytoin
Phenobarbital
Nevirapine
Rifampin
Griseofulvin
Carbamazepine

Chronic alcoholics Steal
Phen-Phen and Never
Refuse Greasy Carbs

Question 7

CYP 450 Inhibitor

Answer 7

Acute Alcohol Abuse
Ritonavir
Amiodarone
Cimetidine/ciprofloxacin
Ketoconazole
Sulfonamides
Isoniazid (INH)
Grapefruit juice
Quinidine
Macrolides (except azithromycin)

Question 8

Hepatically eliminated drugs have clearances __________ in children than in adults

Answer 8

that vary more widely

Drugs are cleared more rapidly in children (in general), whether eliminated via renal or hepatic processes

Question 9

Renal clearance of drugs is ___________ in children

Answer 9

more predictable

Drugs are cleared more rapidly in children (in general), whether eliminated via renal or hepatic processes

Question 10

Drugs are cleared ________in children (in general), whether eliminated via renal or hepatic processes

Answer 10

more rapidly

Question 11

_______________(including topical agents) are potent inhibitors of growth

Answer 11

Anti-inflammatory corticosteroids

Question 12

Intellectual development can be impaired by ___________

Answer 12

barbiturates

Question 13

Decrease gastric emptying and GI motility

Answer 13

Drugs with anticholinergic actions - diphenhydramine, TCADs

Question 14

Increase gastric emptying and GI motility

Answer 14

Metoclopramide, stimulant laxatives

Question 15

Decrease in hepatic mass and blood flow - ____ per year after age 40

Answer 15

1%

Can decrease first pass metabolism of drugs with high extraction ratio (i.e., blood flow dependent)

Question 16

Phase II reactions (conjugation, glucuronidation) are minimally affected by aging
Examples?

Answer 16

Lorazepam, oxazepam, temazepam

Question 17

Worst offenders of Beers

Answer 17

amitriptyline, diazepam, doxepin

Question 18

Begin with recommendations for appropriate drug use

Look for therapeutic duplication

Optimize monotherapy

Then add drug from different class

Answer 18

START (Screening Tool to Alert doctors to Right Treatment)

Question 19

Within a therapeutic classification, drugs are designated as potentially inappropriate, the clinical concern is identified, and therapeutic alternatives are suggested

Answer 19

STOPP (Screening Tool of Older Person’s potentially inappropriate Prescriptions)

Question 20

Tinnitus, vertigo:

Worsened by

Answer 20

aspirin, aminoglycosides, ethacrynic acid

Question 21

Hypotension:

Worsened by

Answer 21

beta-blockers, calcium channel blockers, diuretics, vasodilators, antidepressants

Question 22

Psychomotor retardation:

Worsened by

Answer 22

benzodiazepines, antihistamines, antipsychotic agents, antidepressants

Question 23

Pharmacology of Urination

GO: Stimulate M – block α1

STOP: ___________

Answer 23

Block M or stimulate α1 - β2-3

Question 24

Overflow (from urinary retention)

Treated with:

Answer 24

a-adrenergic antagonists [tamsulosin]

Question 25

Stress (from urethral sphincter insufficiency unmasked by coughing sneezing, lifting, sneezing)

Worsened by

Answer 25

a-adrenergic antagonists (prazosin, doxazosin)

Question 26

Pharmacology of Urination

GO: ______________

STOP: Block M or stimulate α1 - β2-3

Answer 26

stimulate M – block α1

Question 27

Urge (from detrusor hyperreflexia with sphincter dysfunction – Overactive Bladder)

Worsened by

Answer 27

cholinergic drugs for dementia (AChEIs), diuretics

Question 28

Urge (from detrusor hyperreflexia with sphincter dysfunction – Overactive Bladder)

Treated with

Answer 28

antimuscarinic agents [tolterodine]

Question 29

Constipation

Worsened by

Answer 29

opioid analgesics

antimuscarinic agents

1st gen antihistamines (esp. diphenhydramine)

CCBs- verapamil