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PMCOL 200 > Lecture 8 - Geriatric Pharmacology > Flashcards

Lecture 8 - Geriatric Pharmacology Flashcards

1
Q

why study geriatrics as a unique population?

A

geriatric patients have far more toxicity than any other age groups, they take multiple medications at once, etc.

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2
Q

list the nine factors which make geriatrics a unique speciality

A
  • changes associated with primary aging
  • secondary aging (disease)
  • multimorbidity
  • geriatric syndromes (ex: falls)
  • multiple medications
  • setting of care
  • policy decisions (drug coverage, cost, access)
  • psychosocial issues (widowhood, isolation, poverty)
  • ethics and advocacy (paternalism)
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3
Q

what is the age range for the “young old” category?

A

65-74

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4
Q

what is the age range for the “middle old” category?

A

75-84

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5
Q

what is the age range for the “old old” category?

A

85+

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6
Q

someone who has lived to be 100 years

A

centenarian

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7
Q

someone who has lived to be 110 years

A

super centenarian

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8
Q

someone aged 105-109 years

A

semi-super centenarian

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9
Q

why are older adults broken down into smaller age categories?

A

to minimize the differences in abilities and functions

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10
Q

in 2016, the number of seniors living in Canada surpassed:

A

the number of children living in Canada

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11
Q

what percent of the population was made of senior citizens in July 2022?

A

18.8%

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12
Q

what percent of seniors have at least one chronic condition?

A

76%

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13
Q

the prescence of two or more long-term health conditions

A

multimorbidity

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14
Q

why does multimorbidity present a challenge in drug trials?

A

we study drugs in single conditions, not multiple conditions at once

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15
Q

multimorbitity is associated with ____ and ____

A

age, number of medications (linear)

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16
Q

a state of increased vulnerability from age-associated decline in reserve and function resulting in reduced ability to cope with everyday or acute stressors

A

frailty

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17
Q

a gradual decrease in physiological reserve occurs with aging. in frailty, this decrease is:

A

accelerated and homeostatic mechanisms start to fail

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18
Q

on the clinical frailty scale: people who are robust, active, energetic, and motivated. these people commonly exercise regularly.

A

1) very fit

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19
Q

on the clinical frailty scale: people who have no active disease symptoms, and exercise somewhat often.

A

2) well

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20
Q

on the clinical frailty scale: people whose medical problems are well controlled, but are not regularly active beyond reoutine walking

A

3) managing well

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21
Q

on the clinical frailty scale: people who are not dependent on others for daily help, but often symptoms limit activities

A

4) vulnerable

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22
Q

on the clinical frailty scale: these people often have more evident slowing, and need help in high orders tasks (ex: finances, housework).

A

5) mildly frail

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23
Q

on the clinical frailty scale: people need help with all outside activities and with keeping house. inside, they often have problems with stairs and need help with bathing, and might need minimal assistance with dressing

A

6) moderately frail

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24
Q

on the clinical frailty scale: people are completely dependent for personal care, from whatever cause (physical or cognitive). even so, they seem stable and not at high risk of dying

A

7) severely frail

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25
Q

on the clinical frailty scale: people who are completely dependent, approaching th end of life. typically, they could not recover even from a minor illness

A

8) very severely frail

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26
Q

on the clinical frailty scale: people who are approaching the end of life (life expectancy of <6 months)

A

9) terminally ill

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27
Q

a multifactorial condition that involves the interaction between identifiable situation-specific stressors and underlying age-related factors, resulting in damage across multiple organ systems

A

geriatric syndrome

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28
Q

what are the four key features of geriatric syndrome?

A
  • clinical and multifactorial conditions in older persons
  • associated with poor health outcomes
  • do not fit into disease categories (co-morbidities)
  • require a multidimensional treatment approach
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29
Q

go review slide 216 of your notes

A

you’re doing great!

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30
Q

what is pharmacoepidemiology?

A

a multifaceted discipline that combines the principles of both pharmacology and epidemiology for the study of the use and effects of drugs in extensive populations

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31
Q

a medication or medication class where harm outweighs the benefit, and there are safer alternatives available

A

potentially inappropriate medications

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32
Q

the Beers criteria is used by the Canadian Institute of Health Information (CIHI) and American Geriatrics Society (AGS) to identify:

A

potentially inappropriate medications (PIMs)

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33
Q

what is the goal of the WHO Global Patient Safety Challenge?

A

the reduce severe, avoidable medication-related harm by 50% over the course of 5 years

34
Q

how much money does medication errors cost?

A

$42 billion USD

35
Q

what are the priority actions of the WHO Global Patient Safety Challenge?

A
  • managing high risk situations (including children and older adults)
  • polypharmacy
  • transitions in care
36
Q

which groups are at the highest risk of experiencing an adverse drug reaction (ADR)?

A

1) people with multiple chronic conditions
2) women
3) people over the age of 65

37
Q

what is polypharmacy?

A

literally, taking 2 or more medications; but practically, taking 5 or more medications

38
Q

the use of one drug to treat the adverse effects of another

A

drug cascades (polypharmacy)

39
Q

not prescribing medications to patients who would benefit from it

A

potential prescribing omissions (PPO)

40
Q

PPO is often seen in patients with:

A

polypharmacy

41
Q

recent studies of hospitalized patients show ____% admitted had a PPO per the ____

A

83%, START criteria

42
Q

what is the START criteria?

A

says: that’s a potentially appropriate medication that you should continue on or start

43
Q

true or false: aging is synonymous with disease

A

false

44
Q

each organ system has changes associated with aging, which often starts in the:

A

fifth decade

45
Q

what are five implications of physiologic aging?

A
  • reduced tissue/organ function
  • functional decline
  • increased susceptibility to disease
  • change in behaviour
  • differences in pharmacokinetics and pharmacodynamics
46
Q

how does body composition change with age?

A

loss of muscle mass, function and quality of muscle changes, fat mass increases

47
Q

how does the cardiovascular system change with age?

A

decreased cardiac output, decreased beta sensitivity

48
Q

how does the renal system change with age?

A

decreased glomerular filtration rate, decreased nephrons

49
Q

how does the gastrointestinal system change with age?

A

decreased H+, increased gastric emptying time

50
Q

how does the hepatic system change with age?

A

decreased size, decreased blood flow

51
Q

how does the nervous system change with age?

A

decreased blood flow to the CNS

52
Q

how does the pulmonary system change with age?

A

decreased cilia

53
Q

how does the endocrine system change with age?

A

decreased hormonal secretions

54
Q

how does gastrointestinal absorption change with aging?

A
  • potential for delay in absorption
  • active transport may be reduced
55
Q

how does intramuscular/topical absorption change with aging?

A
  • slower, erratic, or lower absorption
  • higher absorption of topical steroids
56
Q

most drugs are _____ in older adults

A

well absorbed

57
Q

drug absorption can be affected by:

A

other conditions or medications

58
Q

what is the affect on Vd as body water levels decrease with age?

A

decreased Vd for hydrophilic drugs

59
Q

what is the affect on Vd as lean mass decreases with age?

A

decreased Vd for drugs that bind to muscle, or are water soluble

60
Q

what is the affect on Vd as fat stores increase with age?

A

increased Vd for lipophilic drugs

61
Q

what is the affect on Vd as albumin levels decrease with age?

A

increased percent of unbound or free drug

62
Q

protein changes with aging are:

A

insignificant and rarely have an impact on drug therapy

63
Q

protein changes often occur with:

A

concurrent illness, not aging

64
Q

what physiological changes impact drug metabolism?

A

decreased hepatic mass, hepatic blood flow, and CYP P450 content

65
Q

what are the pharmacokinetic effects of altered metabolism associated with age?

A

decreased first pass metabolism, phase I metabolism, and phase II metabolism (if frail older adult)

66
Q

what is the effect of reduced phase I metabolism?

A

slower/lower conversion to metabolites

67
Q

phase II metabolism is largely _____ in older adults, with the exception of _____

A

in tact, frail older adults

68
Q

drugs metabolized by _____ are preffered in older adults

A

phase II metabolism

69
Q

for medications that are oxidatively metabolized, the dose must be ______ for older adults

A

reduced

70
Q

multiple medications can have a more dramatic drug interaction if impacting the:

A

CYP P450 enzyme system

71
Q

metabolism of drugs can be dramatically affected by _____ in older adults

A

illness (particularly acute illness)

72
Q

other factors which affect drug metabolism include:

A

chronic illness, genetics, diet, smoking, and ethanol use

73
Q

what physiological changes impact drug elimination?

A

decreased renal blood flow, glomerular filtration rate, and tubular secretion

74
Q

what are the pharmacokinetic effects of altered elimination associated with age?

A

renally eliminated drugs are delayed, and there is a longer half-life of renally eliminated drugs

75
Q

what is the single most clinically significant change in pharmacokinetics due to aging?

A

decreased renal elimination of drugs

76
Q

the majority of drug dosage adjustments in older adults are due to:

A

renal function

77
Q

what are the pharmacodynamic changes associated with aging?

A
  • changes in homeostatic regulation
  • change in receptor responsiveness
  • increased sensitivity to drugs
78
Q

what are the changes in receptor responsiveness associated with aging?

A
  • change in receptor density
  • change in receptor affinity
  • post-receptor changes
  • change in negative feedback
79
Q

what is the paradox of drug exposure?

A

in most cases there is increased sensitivity, but we would expect decreased sensitivity

80
Q

increased drug sensitivity leads to:

A

increased risk of an adverse drug event (ADE)

PMCOL 200 (8 decks)

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