Pharm - Geriatrics Flashcards
Given the change in pH with age, what do you expect to happen if an elderly patient takes an antifungal?
- antifungals require acidity for digestion but pH increases with age so efficacy will be decreased
How might the change in ratio between adipose and lean tissue in the elderly change the efficacy of antipsychotics?
the greater increase in adipose tissue will increase the efficacy of antipsychotics because they are lipophilic
How might the change in ratio between adipose and lean tissue in the elderly increase the risk of aminoglycoside related side effects?
- less lean tissue decreases the amount of water
- aminoglycosides are hydrophilic
- net effect = greater concentration in lower volume = more side effects
In general what is the trend in albumin vs. alpha 1 glycoprotein with aging?
- albumin decreases
- alpha 1 glycoprotein increases
What cytochrome family of enzymes are not only located in the liver but in the intestinal tract as well?
CYP450 3A 4/5 enzymes
Given the decrease in phase 1 reactions seen with aging how might this effect an active drug vs a pro drug?
- more active drug will reach systemic circulation
- less active drug will be made from pro drug
The recommended dose of this drug is specifically defined by the age of the patient.
- Ambien (Zolpidem)
What is the primary reason benzodiazepines are prescribed for the elderly?
insomnia
What is the primary reason benzodiazepines are prescribed for the younger population?
anxiety
What is the trend in benzo prescription with age in the U.S.?
- increases with age
Abrupt cessation of benzodiazepines leads to what?
- rebound insomnia
What are the 2 adverse effects you are concerned for in the elderly population who take benzos?
- increased risk of falls
- impair cognition
What other drug class has the same adverse effects as benzos in the elderly?
- opioids
What tends to happen with age to nephrons in the kidney?
- nephrons decrease with age
What is the most accurate measurement of estimated kidney function?
- 24 hr urine collection
Why is a low creatinine level in the elderly misleading?
- creatinine is a breakdown product of muscle and most elderly patients have low muscle mass
- round up to 1
FQs increase the risk of tendinitis and tendon rupture in what population?
- those over the age of 60
- who are transplant recipients
- and are on steroids
What are the 2 most prevalent predictors of creatinine clearance?
- genes
- other drugs
What is the major drug class that accounts for the majority of ED visits in patients over 65 years old?
- antithrombotics
What is the major drug class that accounts for the majority of ED visits in the adolescent populations?
- antibiotics
Why is there a drug-drug interaction between macrolides and non-DHP CCBs?
- macrolides are CYP inhibitors so more CCB is available is bioavailable
NSAIDs may lead to what adverse effect that then requires treatment with another drug?
- HTN
DHB CBBs may lead to what adverse effect that then requires treatment with another drug?
- peripheral edema
HCTZ may lead to what 2 adverse effects that then requires treatment with another drug?
- changes in K+
- impaired clearance of uric acid
Pseudoephedrine may lead to what 4 adverse effects that then requires treatment with another drug?
- increase BP
- insomnia
- rebound congestion
- urinary retention
Metoclopramide may lead to what adverse effect that then requires treatment with another drug?
- parkinson like symptoms
Any patient with HF should avoid or minimize this drug class due to its effect on the kidneys.
- NSAIDs
What is the mechanism of action of Donepezil (Aricept) for treatment of dementia?
- inhibits the enzyme acetylcholinesterase which increases Ach
What is the second line treatment for dementia if cholinesterase inhibitors does not work?
- NMDA antagonists (Memantine [Namenda])
What is the preferred anxiolytic in the elderly?
- buspirone
Why is adherence important with DOACs?
- they are short acting drugs so you can’t miss a dose
Most patients will not tolerate cholinesterase inhibitors d/t this side effect.
- nausea
