Peds + Ger Pharm Flashcards
Which one, hepatically eliminated drugs, or renally cleared drugs are more predictable in children?
Renal clearance of drugs: more predictable in children
- more rapidly cleared in children than adults
*hepatically elim vary more widely
Maintenance dose are higher in children or adults?
Children
*drugs are cleared more rapidly in children
(renal or hepatic)
Therapeutic lvls of plasma drugs (Cp) are higher in children or adults?
Same
- dosage regimens reflect size and age related changes in Vd and CL
- dosage adjustments are NOT necessary
Why not use aspirin in children prior to puberty?
Risk for hepatic dysfxn
Increased risk for Reyes syndrome
- fatty liver w/ acute encephalopathy
- salicylate intxn w/ chicken pox and influenza
Is aspirin renally or hepatically elim?
Renally
- but conjugated in liver to metabolites
*Hepatic elim is DQ CRIMES
Geriatrics have a decrease in gastric acid production (increase pH). So they will have:
______ absorption of weak acid drugs.
______ absorption of weak base drugs
Decrease abs of weak acid
- warfarin, PCN
Increase abs of weak base
- BDZ, Opioid analg, anticonvulsants, TCADs
How much change does loading dose of drugs change with age?
Very little
- the body proportions and fat distribution change with age, but the effects of these changes on VOLUME OF DISTRIBUTION (Vd) are relatively insignificant for most drugs.
- So it makes sense that if Vd doesnt change much, then loading dose wont need to be changed either
- note: changes in Vd associated w/ aging may require dosage adjustment
In the first month of life, (pick one) Hepatic/Renal metabolism is highly variable. So in the FIRST month of life, dosage for drugs metabolized by _____ need to be indiv. adjusted.
Hepatic metabolism
Liver
*patterns of hepatic detoxification (young, old, diff people) are highly individual
Hepatic metabolism at birth is _____ relative to adults.
Poor
- hepatic met still needs to mature in postnatal age
- vary very widely in children, more than in adults
Is renal or hepatic clearance more rapidly cleared in children?
Renal clearance: more rapid in children
- hepatic elim AT BIRTH is poor relative to adults
- renal dosing should also be considered in elderly - lower CrCl
Medication dosing for infants and children should be based on what?
Weight (mg/kg) or
Body SA (mg/m2)
If medication is difficult to deliver, can you mix meds in a bottle of milk or formula?
No
- failure to consume entire bottle = fail to deliver entire dose.
*always deliver oral liq meds in syringe, dropper, or cup. (kitchen teaspoon can range)
Elderly account for what % of drug related deaths?
50%
Old people have a decrease in gastric emptying and GI motility, so what drug do you have to be worried about bc it has the same FXs?
Anticholinergics
*no pee
no see
no spit
no shit
For the elderly, the rate of absorption to peak may be changed with aging. Is the extent of the absorption also changed?
No
Bioavailability, aka Extent of absorption usually not changed much w/ most meds.
Phase I or II metabolism:
which goes first with age?
Phase I
- decreases with age in 30-35% of elderly
Phase II is minimally affected
What marker can you use to determine hepatic drug metabolizing capacity?
None exists sucker
Dosage is hard, titrate, titrate, titrate.
Is lorazepam or diazepam better in elderly?
Lorazepam - phase I elimination
Beers list
- what is it
explicit criteria for determining potentially inappropriate med in elderly
- meds to avoid, to use w/in dose range
- meds to avoid in elderly with specific other diseases
STOPP and START
STOPP
Screening Tool of Older Person’s potentially inappropriate Prescriptions
START
Screening Tool to Alert doctors to Right Treatment
In the elderly: supporting structures (arthralgias, myopathies, osteoporosis) are worsened by which drugs?
Corticosteroids
Phenytoin
Heparin
Decreased Vit D intake
In the elderly: Movement disorders (extrapyramidal disorders) are worsened by:
Antipsychotic agents
Metoclopramide
In the elderly:
Tinnitus, vertigo is worsened by
Aspirin
AG
Ethacrynic acid
In the elderly:
Hypotension is made worse by:
BB
CCB
Diuretics
Vasodilators
Antidepressants
In the elderly:
Psychomotor retardation is worsened by:
BDZ
Antihistamines
Antipsychotic agents
Antidepressants
What % of persons >65 who live in the community fall each yr?
1/3
- leading cause of non-fatal injuries and hospital admissions
tx for overflow incontinence from urinary retention
a-adrenergic antagonist (tamsulosin)
*note: this makes stress incontinence worse
Tx for urge incontinence from detrusor hyperreflexia with sphincter dysfxn
antimuscarinic agent
(tolterodine)
*note: you give tamsulosin for overflow incontinence from urinary retention
