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Geriatrics > Pharmacology and Aging > Flashcards

Pharmacology and Aging Flashcards

1
Q

What is the BEERs criteria?

A

Listing of drugs that should not be used in the elderly

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2
Q

True or false: formulations change frequently

A

True

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3
Q

What are nutraceuticals?

A

Herbal preps
Nutritional supplements
etc

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4
Q

What are the four factors of pharmacokinetics?

A

Absorption
Distribution
Metabolism
Elimination

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5
Q

True or false: amount absorbed (bioavailability) is not changed in the elderly

A

True

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6
Q

What happens to peak concentrations in the elderly? What are the exceptions to this?

A

Lower and delayed

Extensive first pass effect

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7
Q

What are the factors that affect drug absorption? (4)

A

Route
What taken with
Comorbidities
Gastric pH

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8
Q

What is the effect of divalent cations on drug absorption?

A

Affect absorption of fluoroquinolones

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9
Q

Enteral feedings interfere with what?

A

Absorption of some drugs

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10
Q

What type of drugs particularly affect absorption?

A

Drugs that affect GI motility

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11
Q

Decreased body water has what effect on drug absorption?

A

Lower VD for hydrophilic drugs

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12
Q

Decreased lean body mass has what effect on drug absorption?

A

Lower VD for drugs that bind muscle

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13
Q

Increased fat stores has what effect on drugs?

A

Higher VD for lipophilic drugs

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14
Q

Decreased plasma protein (albumin) has what effect on drugs?

A

Higher percentage of drug that is unbound

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15
Q

Generally, men or women metabolize drugs faster?

A

Men

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16
Q

What is the effect of smoking on drug clearance?

A

Increases clearance for some drugs

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17
Q

CHF has what effect on the liver?

A

Hepatic congestion (lowered metabolism)

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18
Q

What is half-life?

A

Time for serum [c] of drug to decline by 50%

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19
Q

What is drug clearance?

A

Volume of serum from which the drug is removed per unit of time (L/hour or mL/min)

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20
Q

What is the most common reason for A-fib?

A

HTN

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21
Q

Smoking increases the clearance of what drug in particular?

A

Theopylline

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22
Q

Most drugs exit the body through what route?

A

Kidney

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23
Q

What is the consequence of reduced elimination of drugs through the kidneys?

A

Drug accumulation and toxicity

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24
Q

What are four factors of the kidneys decrease in old age?

A

Size
RBF (GFR)
Nephrons
Renal tubular secretion

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25
What is the first system that is usually effected d/t bad drug interactions?
GI system
26
What is the drug that is hard on the kidneys?
IV/oral contrast
27
Lower body mass does what to creatinine clearance? GFR?
Lowers
28
What are the two ways to determine creatinine clearance?
Measure (24 hr urine collection) Estimate (cockroft-gault equation)
29
Is an 8 hour creatinine clearance acceptable?
No
30
What is the equation for the cockroft gault equation?
[(Ideal weight)(140-age) / 72(serum Cr)] * 0.85 if female
31
In pts without a significant age related decline in renal function, is CrCl under or overestimeated?
Under
32
What is the major issue with Benzos?
Increases fall risk
33
True or false: older pts may experience longer pain relief with morphine
True
34
True or false: Benzos should not be used for sleep. Explain.
True--addicting
35
What are the four factors that are needed for successful pharmacotherapy?
Correct drug, dose, condition Is appropriate for pt
36
ADEs are responsible for what percent of acute geriatric hospital admission?
5-28%
37
What percent of ADEs occur in community dwelling older adults?
35%
38
What are the most common drugs that cause ADEs? (5)
``` Cardio Diuretics NSAIDs Hypoglycemics Anticoags ```
39
What general characteristic of a drug is associated with ADEs?
Ones with narrow margin of safety
40
What food is bad for CHF pts?
BBQ (salt)
41
What percent of ambulatory adults receive at least one potentially inappropriate med?
>20%
42
What can underprescribing result from?
Assuming older adults will not benefit from Meds intended as prim or sec prevention Aggresive
43
What is the most common drug that causes drowsiness?
Benadryl
44
ACE inhibitors usually cause what?
Cough
45
Long term beta blocker use can cause what?
Depression
46
How many concurrent chronic conditions are a risk factor for ADEs?
6 or more
47
How many doses of drugs/day are a risk factor for ADEs?
12 or more
48
How many meds are a risk factor for ADEs?
9 or more
49
True or false: prior adverse drug events are not a risk factor for ADEs
False
50
What age is considered a risk factor for ADEs?
85+
51
What is the CrCl that is a risk factor for ADEs?
52
What are the most common drug-drug interactions?
Cardio and psychotropics
53
What is the pathway that is utilized in drug metabolism?
CYP3A4 (p450)
54
What are the symptoms of drug-drug interactions? (4)
Confusion/delirium Cognitive impairment Hypotension Acute renal failure
55
What should you consider before adding a drug?
Is this used to treat side effects of another drug?
56
What are the two things that cause nonadherence to drugs?
Failure of dr to consider pts situation Pts not understanding
57
Over prescribed or under-prescribed: Antiinfective agents
Over
58
Over prescribed or under-prescribed: anticholinergic agents
Over
59
Over prescribed or under-prescribed: ACE inhibitors for pts with DM and proteinuria
Under
60
Over prescribed or under-prescribed: angiotensin-receptor blockers
Under
61
Over prescribed or under-prescribed: Urinary and GI antispasmodics
Over
62
Over prescribed or under-prescribed: antipsychotics
Over
63
Over prescribed or under-prescribed: Benzos
Over
64
Over prescribed or under-prescribed: antigoagulants
Under
65
Over prescribed or under-prescribed: antihypertensive agents and diuretics for uncontrolled HTN
Under
66
Over prescribed or under-prescribed: digoxin for diastolic dysfuntion
Over
67
Over prescribed or under-prescribed: dipyridamole
Over
68
Over prescribed or under-prescribed: H2 receptor agonist
Over
69
Over prescribed or under-prescribed: laxatives and fecal softeners
Over
70
Over prescribed or under-prescribed: beta blocks for pts after an MI
Under
71
Over prescribed or under-prescribed: bronchodilators
Under
72
Over prescribed or under-prescribed: PPIs for GI protection from NSAIDs
Under
73
Over prescribed or under-prescribed: statins
under
74
Over prescribed or under-prescribed: NSAIDs
Over
75
Over prescribed or under-prescribed: PPIs
Over
76
Over prescribed or under-prescribed: Sedating antihistamines
Over
77
Over prescribed or under-prescribed: TCAs
over
78
Over prescribed or under-prescribed: vitamins and minerals
Over
79
Over prescribed or under-prescribed: vitamin D
Under

Geriatrics (30 decks)

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