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Pharm Exam 3 > Oldies > Flashcards

Oldies Flashcards

1
Q

Most common drug classes used by older adults

A

analgesics, diuretics, cardiovascular drugs, and sedative hypnotics

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2
Q

What happens to absorption in older adults?

A

Reduced GI blood flow and motility
Reduced gastric acidity
Reduced absorptive surface from microvilli atrophy

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3
Q

Which drugs tend to have a reduced absorption in the elderly?

A

drugs (levodopa, propylthiouracil) whose chemical structures are similar to endogenous substances (sugars, amino acids, peptides, iron salts) requires active transport

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4
Q

What happens to the first-pass effect in the elderly?

A

reduction of hepatic first-pass effect may lead to increased bioavailability

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5
Q

What happens to fluid volume in the elderly?

A

Total body water and extracellular fluid volume decrease with age and the of total body fat rises

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6
Q

What can happen with water soluble drugs in the elderly?

A

water-soluble drugs have a reduced volume of distribution, leading to increased plasma concentrations of hydrophilic (water-soluble) drugs such as lithium

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7
Q

Lipophilic drugs in the elderly result in what?

A

Because body fat increases with age, lipophilic (lipid-soluble) drugs will have an increased half-life from increased storage in fatty tissue - need to be adjusted

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8
Q

What happens to drugs in hypoalbuminemia?

A

Because of hypoalbuminemia, the free or unbound fraction increases, thereby increasing the drug’s effect

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9
Q

Hypoalbuminemia + phenytoin

A

With hypoalbuminemia, the therapeutic range for phenytoin becomes substantially lower

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10
Q

What happens with serum Cr in the elderly?

A

Because older adults have reduced muscle mass, the serum Cr may be falsely low as an indicator of GFR

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11
Q

What happens to the CrCl formula in the elderly?

A

May be falsely low d/t the falsely low serum Cr

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12
Q

If serum Cr is < 1 what should be done in the elderly?

A

Round up to 1 when calculating CrCl

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13
Q

How do elderly react to furosemide and BB and B agonists?

A

Because older adults have reduced muscle mass, the serum Cr may be falsely low as an indicator of GFR

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14
Q

What is a common SE of tx HTN in the elderly?

A

Orthostatic hypotension

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15
Q

What is the first tx option in older adults in tx HTN?

A

Low dose diuretic or ACE inhibitor (prils)

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16
Q

What is the (ALLHAT, 2006) trial outcome?

A

Thiazide diuretic was superior in preventing these outcomes

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17
Q

What is the most effective tx of HTN in the elderly?

A

low-dose diuretics are most effective first-line treatment for treating HTN in older adults

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18
Q

BB vs diuretics in the elderly

A

diuretic therapy is superior in preventing vascular events

19
Q

Major SE of CCB in the elderly?

A

peripheral edema

20
Q

What is 2nd line in tx HTN in the elderly?

A

ACE Inhibitors/ ARBs

21
Q

What to watch out for in ACE Inhibitors/ ARBs?

A

Chronic cough

22
Q

MC neuroleptics used to help tx dementia

A

haloperidol (Haldol), risperidone (Risperdal), and quetiapine (Seroquel)

23
Q

Which benzo is typically used in the elderly if necessary to tx delirium?

A

Lorazepam (Ativan) has wide acceptance because it is short-acting

24
Q

Cholinesterase Inhibitors (ChEs) examples

A

donepezil
rivastigmine
galantamine

25
Q

Mild and moderate tx for DA

A

Rivastigmine and galantamine are FDA approved for the treatment of both the mild and moderate stages of Alzheimer’s Disease

26
Q

Which ChE is approved to tx all 3 stages of AD?

A

Donepezil is approved for all three stages of Alzheimer’s Disease—mild, moderate, and severe

27
Q

Which drugs should be avoided in pts on ChE?

A

avoid drugs with anticholinergic side effects, such as antihistamines or antimuscarinic drugs used for urinary incontinence (oxybutynin)

28
Q

In which pts should ChEs be used in w/ caution?

A

Further caution in patients with cardiac disorders
Caution should be taken in patients with problems urinating

29
Q

NMDA Inhibitor: Memantine (Namenda) MOA

A

Inhibits N-methyl-D-aspartate channels

30
Q

What type of AD is Memantine approved to tx?

A

FDA approved for patients with moderate and severe Alzheimer’s Disease, not the mild stage

31
Q

Memantine SE

A

dizziness, headache, confusion, coughing, somnolence, pain, vomiting, and hallucinations

32
Q

Muscarinic Antagonists examples

A

Oxybutin
Trospium

33
Q

Muscarinic Antagonists MOA

A

All are reversible acetylcholine receptor blockers that block the muscarinic or parasympathetic nerve endings on the detrusor muscle of the bladder

34
Q

Use of muscarinic antagonists

A

For urge incontinence in cognitively intact patients
Not indicated for nonspecific incontinence or other types of UI

35
Q

What should Muscarinic antagonists NOT be combined with?

A

Do not combine cholinesterase inhibitors (such as donepezil) with these drugs because they have opposing mechanisms of action

36
Q

In which pts should muscarinic antagonists be avoided in?

A

Pts with AD

37
Q

Amiodarone can cause a serious drug interaction when combined with?

A

Serious drug interactions with digoxin and warfarin

38
Q

What is the MC use for warfarin?

A

chronic nonvalvular atrial fibrillation

39
Q

Which drugs can cause parkinsonism in older adults?

A

Antihistamine/antinauseants: promethazine (Phenergan), prochlorperazine (Compazine), and metoclopramide (Reglan)
Antipsychotics

40
Q

Parkinsonism tx

A

D/c drug and carbidopa-levadopa

41
Q

Antipsychotics Black Box warning in the elderly

A

Increased mortality in elderly w/ dementia related psychosis

42
Q

Which benzos should be avoided in the elderly?

A

Avoid use of the following long-acting benzodiazepines:
Diazepam (Valium)
Chlordiazepoxide (Librium)
Chlorazepate (Tranxene)
Flurazepam (Dalmane)

43
Q

What should be checked in older adults on steroids?

A

All older adults on chronic steroids should have assessment of bone density and receive adequate calcium and vitamin D

44
Q

Which NSAID should be avoided in the elderly?

A

Celecoxib

Pharm Exam 3 (7 decks)

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