Oldies Flashcards
Most common drug classes used by older adults
analgesics, diuretics, cardiovascular drugs, and sedative hypnotics
What happens to absorption in older adults?
Reduced GI blood flow and motility
Reduced gastric acidity
Reduced absorptive surface from microvilli atrophy
Which drugs tend to have a reduced absorption in the elderly?
drugs (levodopa, propylthiouracil) whose chemical structures are similar to endogenous substances (sugars, amino acids, peptides, iron salts) requires active transport
What happens to the first-pass effect in the elderly?
reduction of hepatic first-pass effect may lead to increased bioavailability
What happens to fluid volume in the elderly?
Total body water and extracellular fluid volume decrease with age and the of total body fat rises
What can happen with water soluble drugs in the elderly?
water-soluble drugs have a reduced volume of distribution, leading to increased plasma concentrations of hydrophilic (water-soluble) drugs such as lithium
Lipophilic drugs in the elderly result in what?
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
What happens to drugs in hypoalbuminemia?
Because of hypoalbuminemia, the free or unbound fraction increases, thereby increasing the drug’s effect
Hypoalbuminemia + phenytoin
With hypoalbuminemia, the therapeutic range for phenytoin becomes substantially lower
What happens with serum Cr in the elderly?
Because older adults have reduced muscle mass, the serum Cr may be falsely low as an indicator of GFR
What happens to the CrCl formula in the elderly?
May be falsely low d/t the falsely low serum Cr
If serum Cr is < 1 what should be done in the elderly?
Round up to 1 when calculating CrCl
How do elderly react to furosemide and BB and B agonists?
Because older adults have reduced muscle mass, the serum Cr may be falsely low as an indicator of GFR
What is a common SE of tx HTN in the elderly?
Orthostatic hypotension
What is the first tx option in older adults in tx HTN?
Low dose diuretic or ACE inhibitor (prils)
What is the (ALLHAT, 2006) trial outcome?
Thiazide diuretic was superior in preventing these outcomes
What is the most effective tx of HTN in the elderly?
low-dose diuretics are most effective first-line treatment for treating HTN in older adults
BB vs diuretics in the elderly
diuretic therapy is superior in preventing vascular events
Major SE of CCB in the elderly?
peripheral edema
What is 2nd line in tx HTN in the elderly?
ACE Inhibitors/ ARBs
What to watch out for in ACE Inhibitors/ ARBs?
Chronic cough
MC neuroleptics used to help tx dementia
haloperidol (Haldol), risperidone (Risperdal), and quetiapine (Seroquel)
Which benzo is typically used in the elderly if necessary to tx delirium?
Lorazepam (Ativan) has wide acceptance because it is short-acting
Cholinesterase Inhibitors (ChEs) examples
donepezil
rivastigmine
galantamine
Mild and moderate tx for DA
Rivastigmine and galantamine are FDA approved for the treatment of both the mild and moderate stages of Alzheimer’s Disease
Which ChE is approved to tx all 3 stages of AD?
Donepezil is approved for all three stages of Alzheimer’s Disease—mild, moderate, and severe
Which drugs should be avoided in pts on ChE?
avoid drugs with anticholinergic side effects, such as antihistamines or antimuscarinic drugs used for urinary incontinence (oxybutynin)
In which pts should ChEs be used in w/ caution?
Further caution in patients with cardiac disorders
Caution should be taken in patients with problems urinating
NMDA Inhibitor: Memantine (Namenda) MOA
Inhibits N-methyl-D-aspartate channels
What type of AD is Memantine approved to tx?
FDA approved for patients with moderate and severe Alzheimer’s Disease, not the mild stage
Memantine SE
dizziness, headache, confusion, coughing, somnolence, pain, vomiting, and hallucinations
Muscarinic Antagonists examples
Oxybutin
Trospium
Muscarinic Antagonists MOA
All are reversible acetylcholine receptor blockers that block the muscarinic or parasympathetic nerve endings on the detrusor muscle of the bladder
Use of muscarinic antagonists
For urge incontinence in cognitively intact patients
Not indicated for nonspecific incontinence or other types of UI
What should Muscarinic antagonists NOT be combined with?
Do not combine cholinesterase inhibitors (such as donepezil) with these drugs because they have opposing mechanisms of action
In which pts should muscarinic antagonists be avoided in?
Pts with AD
Amiodarone can cause a serious drug interaction when combined with?
Serious drug interactions with digoxin and warfarin
What is the MC use for warfarin?
chronic nonvalvular atrial fibrillation
Which drugs can cause parkinsonism in older adults?
Antihistamine/antinauseants: promethazine (Phenergan), prochlorperazine (Compazine), and metoclopramide (Reglan)
Antipsychotics
Parkinsonism tx
D/c drug and carbidopa-levadopa
Antipsychotics Black Box warning in the elderly
Increased mortality in elderly w/ dementia related psychosis
Which benzos should be avoided in the elderly?
Avoid use of the following long-acting benzodiazepines:
Diazepam (Valium)
Chlordiazepoxide (Librium)
Chlorazepate (Tranxene)
Flurazepam (Dalmane)
What should be checked in older adults on steroids?
All older adults on chronic steroids should have assessment of bone density and receive adequate calcium and vitamin D
Which NSAID should be avoided in the elderly?
Celecoxib
