older adults

Question 1

why is the study of pharmacology critical in older patients

Answer 1

because they have the highest percentage of prescriptions, there are many off-label uses, there are many interactions.

Question 2

does the bioavailibility change with age

Answer 2

no

Question 3

does the peak serum concentration change with age

Answer 3

yes. could be lowre or delayed.

Question 4

what must be kept in mind when considering the serum concentration of an older person

Answer 4

drugs that have first pass effect. their bioavailability may increase because there is less liver and blood flow. this is contradictory to the above card.

Question 5

what can the affect the absorption of drugs

Answer 5

divalent cations, enteral feedings, increased gastric pH, drugs that effect GI motility.

Question 6

what drug is specifically affected by cation

Answer 6

ciprofloxacin -quinolones

Question 7

what drug is specifically affected by enteral feedings

Answer 7

phenytoin

Question 8

what are the effects of aging of distribution

Answer 8

decreased body water means lower VD for hydrophilic drugs.
decreased lean mass means lower VD for muscle bound
increased fat stores means higher VD for lipophilic
decreased plasma protein means a higher percentage of the drug is unbound

Question 9

why would metabolic clearance by the liver be decreased

Answer 9

aging decreases the blood flow, size, and mass of liver,

Question 10

what are the phase I paths

Answer 10

oxidation, hydroxylation, dealkylation, reduction.

Question 11

what does the phase I do

Answer 11

converts drugs to metabolites with greater, lesser or the same effect as the parent compound

Question 12

phase II paths

Answer 12

convert drugs to inactive metabolites that do not accumnulate.

Question 13

what phase metabolism drugs are preferred for older patients

Answer 13

phase II drugs.

Question 14

examples of protein bound drugs

Answer 14

warfarin, barbiturates, phenytoin, carbamezapine

Question 15

examples of phase I drugs

Answer 15

long acting benzodiazepam

Question 16

examples of water soluble drug

Answer 16

digoxin, lithium

Question 17

exampes of lipid soluble drugs

Answer 17

diazepam

Question 18

can gender effect the metabolism of a drug

Answer 18

yes

Question 19

what is the half-life

Answer 19

time for serum conc to decline by 50%

Question 20

what is the clearance

Answer 20

volume of serum for which the drug is removed per unit time

Question 21

where do most drugs exit the body

Answer 21

kidney . if there is reduced elimination there is accumulation and toxicity. aging can impair function

Question 22

what are the effects of aging o n the kidneyh

Answer 22

decreased size, blood flow, number of functioning nephrons, renal tubular secretion. the result is lower GFR

Question 23

does the serum Cr reflect the clearance in an older person

Answer 23

no. there is decreased lean mass, and decreased GFR so the range will stay in the normal masking changes.

Question 24

how do we calculate the Cr clearance

Answer 24

need 24 hr collection to be accurate and cockroft and Gault equation.

Question 25

what is the pharmacodynamics

Answer 25

time course and intensity of the pharmacological effects of a drug.

Question 26

do the pharmacodynamics change with age

Answer 26

yes. likely by reduced clearance.

Question 27

what are the most common medications that cause ADE

Answer 27

cardiovascular, CNS, MSK. meds that have a narrow therapeutic window.

Question 28

what are the risks for ADE

Answer 28

``` 6 or more concurrent chronic conditions 12 or more doses of drugs/day 9 or more meds prior adverse reaction low body weight or BMI older than 85 CrCl<50 ```

Question 29

what are ADE misinterpreted as

Answer 29

new medical conditions

Question 30

what are the risks for drug-drug interactions

Answer 30

increased number of medications consumed esp high risk, multiple prescribers, multiple pharmacies, physiologic and pharmacokinetic changes

Question 31

what are the most common drug-drug interactions

Answer 31

cardiovascular and psychotropic

Question 32

what are the key facts of drug drug

Answer 32

absorption can up or down, drugs with similar or opposite effects can result in changes in effect, drug metabolism can be induced or inhibited. herbals!

Question 33

most common adverse affects of drug drug

Answer 33

confusion, cognitive impairment, arterial hypotension, acute renal failure.

Question 34

ACEi and diuretic risk

Answer 34

hypotension and hyperkalemia

Question 35

ACEi and potassium risk

Answer 35

hyperkalemia

Question 36

antiarrhythmetic and diuretic risk

Answer 36

electrolyte imbalance and arrhythmias

Question 37

benzo and antidepressant, antipsychotic, or benzo

Answer 37

confusion, sedation, falls,

Question 38

CCB and diuretic or nitrate

Answer 38

hypotension

Question 39

digatalis and antiarrhythmetic

Answer 39

bradycardia and arrhythmia

Question 40

what is a drug-disease interaction

Answer 40

when a drug interacts with aberrant physiology of the patient

Question 41

what is the interaction between obesity and lipophilic drugs

Answer 41

there is a greater VD.

Question 42

what disease can affect hydrophilic drugs

Answer 42

ascites

Question 43

what can dementia do to drugs

Answer 43

increase the sensitivity induce paradoxical reactions

Question 44

what are the principles for prescribing to an older

Answer 44

start low and go slow. titrate upward slow. avoid starting 2 drugs