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Pharmacology 2 > Pharm in Elderly > Flashcards

Pharm in Elderly Flashcards

1
Q

what physiological change leads to the greatest effect on pharmacokinetics and pharmacodynamics?

A

decreased hepatic and renal function

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2
Q

why is absorption of certain drugs changed in elderly patients? (2)

A

longer gastric emptying time
decreased gastric acid production = alkaline environment

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3
Q

what 4 drugs will have less bioavailability and exposure in elderly patients due to their decreased gastric acid production?

A

ketoconazole
itraconazole
atazanavir
kinase inhibitors (COVID)

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4
Q

how does a decreased body water in elderly effect distribution? what’s a drug example?

A

increase concentration (Cp) of hydrophilic drugs (lithium)

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5
Q

how does a decreased lean body mass in elderly effect distribution? what’s a drug example?

A

decreased volume of destribution (Vd) for drugs that bind to muscle (digoxin)

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6
Q

how does increased fat in elderly effect distribution? what’s a drug example?

A

increase half life of lipophilic drugs (diazepam)

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7
Q

how does a decreased albumin in elderly effect distribution? what’s a drug example?

A

increase concentration of unbound drugs (warfarin)

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8
Q

how does a decreased alpha-acid glycoprotein in elderly effect distribution? what’s a drug example?

A

increased concentration of unbound drugs (propranolol)

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9
Q

what must be done in elderly when there is an increased effect on distribution?

A

decrease dose

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10
Q

obesity in elderly leads to higher bioavailability of ____________ drugs

A

lipid-soluble

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11
Q

ascites in elderly leads to higher bioavailability of ____________ drugs

A

water-soluble

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12
Q

what does a decrease in perfusion and cardiac output lead to in elderly? (5)

A

increased drug circulation time
prolonged distribution
delayed absorption
delayed Tmax
delayed onset of effect

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13
Q

how is distribution effected in elderly? (2)

A

decreased efficacy of BBB = increased pharmacological response

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14
Q

how is metabolism in the elderly effected? (3)

A

decreased liver size
lower liver blood flow
reduced phase 1 activity (P450 enzyme)

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15
Q

which 3 drugs that go through phase 1 activity (P450 enzyme) will have lower metabolism in elderly?

A

diazepam to desmethyldiazepam
temazepam
oxazepam

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16
Q

which type of drugs do we want to use in elderly to maintain normal metabolism?

A

phase 2 inactivity

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17
Q

what 3 drugs that go through phase 2 inactivity will help maintain a normal metabolism in elderly?

A

lorazepam
temazepam
oxazepam

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18
Q

how will bioavailability be affected in elderly after oral administration?

A

increased

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19
Q

how is excretion of drugs effected in elderly? what 2 drugs?

A

decreased
penicillin
aminoglycosides

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20
Q

what causes a change in excretion of drugs in elderly? (4)

A

decreased renal blood flow
decreased GFR
decreased functioning neurons
decreased tubular secretion

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21
Q

during which 2 times are compensatory mechanisms important to maintain glomerular perfusion pressure and renal function?

A

periods of decreased intravascular volume
periods of decreased perfusion pressure d/t renal artery stenosis

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22
Q

which 2 endogenous substances compensate to maintain glomerular perfusion pressure and renal function? what are their jobs?

A

angiotensin II - potent vasoconstrictor (efferent)
PGs - potent vasodilator (afferent)

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23
Q

which 3 drugs are problematic to GFR in elderly patients?

A

ACEI
ARBs
NSAIDS

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24
Q

how do NSAIDS affect GFR?

A

block PGs
cause vasoconstriction
less fluids into glomerulus
lower pressure
lower GFR

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25
Q

how do ACEIs and ARBS affect GFR?

A

increase vasodilation
drops pressure
drops kidney function
risks renal failure

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26
Q

how is the baroreceptor reflex different in elderly? (3)

A

decreased ability to buffer BP changes
cannot compensate for volume shift
decreased CNS perfusion

27
Q

drug class that relaxes smooth muscle at the bladder neck and prostate, and helps bladder emptying and increases urine flow; used for benign prostatic hyperplasia

A

alpha-1 adrenoceptor antagonist

28
Q

why are alpha-1 adrenoceptor antagonists not recommended for elderly? (2)

A

decrease calcium influx into smooth muscle cells
drops blood pressure

29
Q

elderly are more susceptible to the orthostatic effects of which 4 medications?

A

vasodilators
diuretics
alpha blockers (-sin)
tricyclic antidepressants

30
Q

what does a decrease in the number or affinity of beta receptors lead to?

A

beta agonists + beta blockers become less effective

31
Q

what does a decrease in cholinergic receptors and level of acetylcholine lead to?

A

decreases cognition and memory

32
Q

elderly patients are more sensitive to antagonists of cholinergic receptors. what does this lead to?
what are 5 drugs?

A

exacerbations of cognitive impairments and delirium
TCAs
anti-emetics
urinary antispasmodics
muscle relaxants
antihistamines

33
Q

elderly have an increased sensitivity to dopamine antagonists. what are 2 drugs?

A

antipsychotics
metoclopramide

34
Q

what do dopamine antagonists (antipsychotics and metoclopramide) lead to?

A

increased extra-pyramidal effects

35
Q

what can be a problem in elderly with dopaminergic synthesizing capacity close to the threshold point?

A

decreased dopamine synthesis in substantia nigra

36
Q

what could all dopamine blockers produce in elderly?

A

drug-induced parkinsonism

37
Q

an elderly patient is presenting with uncontrolled movements, grimacing, tongue movements, eyes rolling back, and twisting neck. what is this patient likely taking?

A

dopamine blocker

38
Q

an elderly patient presents with amnesia, agitation, delirium, sedation, psychomotor impairments, ataxia, and imbalance. what are they likely taking?

A

benzodiazepines

39
Q

an elderly patient presents with drowsiness, sedation, constipation, and respiratory depression. what are they likely taking?

A

CNS depressants

antihistamines
antipsychotics
antidepressants
opioids

40
Q

what do antacids cause in elderly? (2)

A

acid-base imbalance
constipation

41
Q

what do corticosteroids cause in elderly? (2)

A

sodium retention
osteoporosis

42
Q

in which patients is osteoporosis worse d/t long-term corticosteroid use?

A

elderly women with low estrogen

43
Q

what do hypoglycemics and insulin cause in elderly? what can make it worse? (3)

A

hypoglycemia

missed meals
alcohol intake
increased exercise

44
Q

what do anti-asthmatics cause in elderly? (2)

A

palpitations
tachycardia

45
Q

what do opiates cause in elderly? (2)

A

analgesia
respiratory depression

46
Q

what do NSAIDS cause in elderly? (3)

A

GI bleed
renal impairment
heart failure

47
Q

what do ACEIs and ARBs cause in elderly? (2)

A

increased serum creatinine
increased potassium

48
Q

why should we be cautious with digoxin in elderly?

A

lower distribution to muscles d/t less muscle
increased concentration in plasma

49
Q

what are the 2 most common ADR and what drugs cause them?

A

increased falls/fractures (antihypertensives)
urinary retention (anticholinergics)

50
Q

elderly tend to have therapeutic duplication with medication that look alike; which 2 meds can cause visual impairments?

A

antifungals
anticholinergics

51
Q

what meds can cause motor problems in elderly?

52
Q

what 2 drugs inhibit the renal tubular secretion of procainamide?

A

cimetidine
trimethoprim

53
Q

what drug inhibits the renal tubular secretion of penicillin?

A

probenecid

54
Q

what drug inhibits the renal tubular secretion of flucloxacillin?

A

piperacillin

55
Q

who is the AGS Beers criteria for?

A

all ambulatory, acute, and institutionalized setting, except hospice and palliative care

56
Q

what can calcium channel blockers and iron cause?

A

constipation

57
Q

what can alpha-blockers cause?

A

orthostatic hypotension

58
Q

what can anti-histamines and TCAs cause? (5)

A

blurred vision
dry mouth
tachycardia
constipation
urinary retention

59
Q

what can benzodiazepines cause?

A

ataxia/falls

60
Q

what D-D interactions exist with warfarin? (5)

A

NSAIDs
sulfa drugs
macrolides
quinolones
phenytoin

61
Q

what D-D interactions exist with ACEI? (2)

A

K supplements
spirolactones

62
Q

what D-D interactions exist with digoxin? (2)

A

amiodarone
verapamil

63
Q

what D-D interaction exists with theophylline??

A

quinolones

Pharmacology 2 (22 decks)

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