Lecture 10- pharm of geriatrics Flashcards
Age associated changes in body composition, metabolism, and pharmacodynamics make _______ use by older adults esp. hazardous
Benzodiazepine
US adults average ______ drugs each, with _____ having more than ______
3-8!
Females more than males
Pharmacokinetics
The study of time course of drugs and metabolite levels in body fluids during absorption, distribution, metabolism, and elimination
Pharmacodynamics
Study of effect of drugs at target site
Pharmacokinetics- Absorption
Many factors influence this
- how drug is taken
- what it is taken with
- Some drugs undergo extensive first pass effects (nitrates)
Pharmacokinetics- Distribution
- the locations in the body that a drug goes to and the time it takes to get there
- hydrophilic- drugs that are water soluble - and have a LOWER volume of distribution
- Lipophilic- Drugs that are fat soluble - have and INCREASES volume of distribution- take lnoger to reach a steady state concentration and have a longer elimination from the body
- Albumin- Primary plasma protein to which drugs bind- decreased in older adults, leaving a higher proportion of a drug unbound or active
The most common site of drug metabolism
the liver
can also occur….
- intestinal wall
- lungs
- skin’
- kidney
drugs most common path of elimination
the kidneys
Steady state
the amount of drug entering is equal to the amount eliminated
In the older and more frail patient…. consider
- lower doses
- longer intervals between doses
- Longer time between dose changes
- Better monitoring
Most older patients will be ______ sensitive to most medications (benzodiazepines and morphine especially)
MORE!!
__% of nursing home patients had at least one inappropriate drug
40
The drugs that are often OVERprescribed
- Anti-infective drugs
- Antipsychotics
- benzodiazepines
- NSAIDs
- Proton-pump inhibitors
- Sedating antihistamines
- Vitamins and minerals
The drugs that are often UNDERprescribed
- ACE inhibitors (diabetic patients)
- Angiotensin-receptor blockers
- Anticoagulants
- Antihypertensive and diuretics
- B blockers after MI’s
Vitamin D and calcium (osteoporosis)
Adverse drug events are the cause of ____ of acute geriatric hospital admissions, or about 100,000 per year
28%
