Pharm for Elderly

Question 1

What factors may affect drug absorption in the elderly?

Answer 1

• Increased gastric pH may inc or dec absorption of some drugs
• Drugs that affect GI motility can affect absorption

Question 2

What factors may affect drug distribution in the elderly?

Answer 2

• Affected by dec body water, dec lean muscle mass, inc fat stores, dec plasma protein

Question 3

What factors may affect drug metabolism in the elderly?

Answer 3

• Metabolic clearance of a drug by liver may be reduced
o Aging dec liver blood flow, size and mass
• Gender affects metabolism
o Ex - Oxazepam is metabolized faster in older males than older females
• Hepatic congestion from CHF
o Ex - Dec metabolism of warfarin
• Smoking
o Inc clearance of theophylline

Question 4

What drugs require hepatic metabolism?

Answer 4

• NSAIDs
• ASA
• CCB
• Acetaminophen
• Histamine 2 Blockers
• PPI’s
• Beta blockers
• SSRI’s

Question 5

What drugs require dose reduction with a decreased Cr clearance?

Answer 5

• Aminoglycosides
• Fluoroquinolones
• Digoxin
• Metformin
• Bisphophonates
• Thiazides
• Atenolol
• ACE inhibitors

Question 6

Why is kidney function critical for drug elimination?

Answer 6

• Reduced elimination in elderly (dec GFR) → drug accumulation and toxicity

Question 7

What is unique about Cr clearance in the elderly?

Answer 7

• Serum Cr in elderly does NOT reflect Cr clearance
o Dec lean body mass → dec Cr production and dec GFR
• Consequently, Serum cr can stay in nl range, masking change in Cr Clearance

Question 8

Which drugs have a high potential for adverse drug reactions?

Answer 8

o Amitriptyline
o Digoxin > 0.125 mg q d
o Anticholinergic GI antispasmodics
o Meperidine IM or IV

Question 9

Which drugs have a lower potential for adverse drug reactions?

Answer 9

o Antihistamines
o Indomethacin
o Meperidine oral
o Muscle relaxants

Question 10

What are the risk factors for adverse drug reactions?

Answer 10

• 6 or more concurrent medical conditions
• 12 or more doses of drugs/day
• 9 or more medications
• Prior adverse drug reaction
• Low body weight or BMI
• Age 85 or older
• Estimated Cr Cl < 50 ml/min

Question 11

What factors increase the risk of drug-drug interactions?

Answer 11

• Inc number of meds consumed
• Multiple prescribers
• Multiple pharmacies
• Physiologic and pharmacokinetic changes

Question 12

What are the most common type of drug-drug interactions?

Answer 12

o Cardiovascular

o Psychotropic drugs

Question 13

What are the most common adverse effects of drug drug interactions?

Answer 13

o Confusion
o Cognitive impairment
o Arterial hypotension
o Acute renal failure

Question 14

What is the MC effect of an ACE I and a diuretic?

Answer 14

hypotension, hyperkalemia

Question 15

What is the MC effect of an ACE I and K?

Answer 15

Hyperkalemia

Question 16

What is the MC effect of an antiarrhythmic and a diuretic?

Answer 16

electrolyte imbalance, arrhythmia

Question 17

What is the MC effect of a benzodiazepine and an antidepressant?

Answer 17

confusion, sedation, falls

Question 18

What is the MC effect of a CCB and a diuretic?

Answer 18

Hypotension

Question 19

What are the basics for prescribing for the elderly?

Answer 19

• Start low and go slow
• Titrate upward slowly
• Avoid starting 2 drugs at the same time

Question 20

What questions need to be asked before starting a new drug?

Answer 20

• Is the med necessary
• What are the therapeutic end points
• Do benefits outweigh risks?
• Is it used to treat side effects of another drug
• Could 1 drug be used to treat 2 conditions
• Could it interact with diseases or other drugs
• Does the pt know what it’s for, how to take it and what ADE’s to look for

Question 21

What needs to be considered before starting a new drug?

Answer 21

• Unique dosage requirements of pt
• The patient’s lifestyle and functional status
• The patient’s cognitive status
• Quality of life issues
• Financial impact of drug therapy
• Pt’s understanding of both the drug and disease