Pharmacology

Question 1

percentage of older adults w/ one or more chronic conditions

Answer 1

80%

drug therapy is primary method of tx

Question 2

consumption of prescribed and non prescription meds

Answer 2

65 yrs and older

prescribed = 31%

nonprescription = 40%

Question 3

what dictates polypharmacy

Answer 3

multiplicity of dz

Question 4

% of older adults that use five or more meds

Answer 4

50

Question 5

% of older adults that use ten or more meds

Answer 5

12

Question 6

institutionalized population is given …

Answer 6

5-8 prescriptions meds compared to community dwellers

Question 7

how does aging affect a drug

Answer 7

absorption

excretion

distribution

metabolism

Question 8

what is absorption

Answer 8

process by which the drug passes from the GI tract into the bloodstream

Question 9

how does absorption occur in older adults

Answer 9

complete in elderly

but occurs at a slower rate

Question 10

age related changes affecting absorption

Answer 10

decreased…

-gastric secretions and acidity
-GI surface area
-gastric emptying
-intestinal motility

Question 11

clinical implications –> absorption

Answer 11

decrease absorption rate

increased time for peak effect

Question 12

what does distribution determine

Answer 12

concentration of the drug

Question 13

what do drugs have an affinity for

Answer 13

certain body component

affecting their action at the target site

Question 14

what does decrease in distribution make the elderly more susceptible to

Answer 14

drug toxicity and side effects

Question 15

age related changes influencing distribution…increasing

Answer 15

peripheral resistance

fat mass

Question 16

age related changes influencing distribution…decreasing

Answer 16

cardiac output

body water content

lean body mass

serum albumin

Question 17

clinical implication –> distribution

Answer 17

decreased volume of distribution of drug

change in response to drug

Question 18

metabolism is also called

Answer 18

biotransformation

Question 19

metabolism

Answer 19

inactivation of the drugs

creates water soluble metabolites that can be excreted by the kidneys

Question 20

what does metabolism determine

Answer 20

length of time the drug is in the body

Question 21

age related changes affecting metabolism

Answer 21

reduction of hepatic blood flow

decreased liver sized

Question 22

reduction of hepatic blood floor –> metabolism

Answer 22

drugs are metabolized more slowly in the elderly

Question 23

clinical implication –> metabolism

Answer 23

drugs that undergo inactivation in the liver –> remain active for longer time

leading to hepatotoxicity

Question 24

excretion

Answer 24

process of elimination of the drug from the body

Question 25

where are drugs majorly excreted

Answer 25

kidneys

Question 26

what do age related changes to the kidneys

Answer 26

overall decrease in excretion decrease in the accumulation of drugs and drug metabolites within the body

Question 27

age related changes affecting metabolism

Answer 27

decline in -renal blood flow -renal mass -renal tube fxn

Question 28

clinical implications related to metabolism

Answer 28

prolong drug effects increase toxic effects on kidneys drug half life is longer in older adults

Question 29

half life

Answer 29

time it takes for the body to remove half of the drug **out of the entire body**

Question 30

common meds used by older adults (1)

Answer 30

antihypertensive ace - inhibitors beta - blockers nitrates

Question 31

common meds used by older adults (2)

Answer 31

statins anticoagulants and antiplatelets diabetic meds glucocorticoids anti-dementia

Question 32

antihypertensive meds

Answer 32

decrease BP and rate if increase if stunted

Question 33

what do hypertensive meds caused

Answer 33

dysrhythmia dehydration

Question 34

ace inhibitors side effects

Answer 34

hypotension

Question 35

beta-blockers medications end in

Answer 35

-lol

Question 36

beta blockers SEs

Answer 36

blunted exercise response

Question 37

what do you use with pts that are on beta blockers

Answer 37

RPE during exercise not HR!!!

Question 38

why dont we use HR with beta blockers

Answer 38

meds change the beat of the heart

Question 39

what do nitrates do

Answer 39

increase peripheral vasculature decrease cardiac workload decrease oxygen demand

Question 40

nitrates SE

Answer 40

hypotension dizziness

Question 41

what do pts with nitrates experience after exercise

Answer 41

vasodilating effects "ok" BP BP falls after exercise

Question 42

what do statins do

Answer 42

improve lipid profile

Question 43

SE of statins

Answer 43

statin induced myopathy weakness

Question 44

anticoagulants and antiplatelets prevent

Answer 44

prevent platelet aggregation

Question 45

SE of anticoagulants and antiplatelets

Answer 45

bleeding bruising HA

Question 46

diabetic meds ex

Answer 46

metaformin

Question 47

where do pts inject insulin

Answer 47

away from exercising muscles

Question 48

what should we always have around when working with pts w/ diabetes

Answer 48

carbs (15 g)

Question 49

glucocorticoids

Answer 49

anti-inflammatory

Question 50

SE of glucocorticoids

Answer 50

steroid myopathy tendon rupture osteoporosis

Question 51

anti-dementia SE

Answer 51

diarrhea depression weight loss mm cramps

Question 52

polypharmacy

Answer 52

excessive prescription and self administration of meds

Question 53

how does polypharmacy occur

Answer 53

multiple providers may be unaware of new prescriptions or med changes esp after hospitalization

Question 54

what plays a role in the absorption of drugs

Answer 54

smoking/alcohol

Question 55

adverse drug reaction (ADR)

Answer 55

noxious, unintended reactions that occur at doses normally used for dx, prophylaxis or tx

Question 56

how does polypharmacy relate to PT

Answer 56

need to know the beneficial and adverse effects of each meds and how they can affect the rehab of our pts

Question 57

what could we do as PTs

Answer 57

recognize ADRs encourage proper adherence to drug therapy discourage improper use of unnecessary meds