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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
Q

What is the first system that is usually effected d/t bad drug interactions?

A

GI system

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26
Q

What is the drug that is hard on the kidneys?

A

IV/oral contrast

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27
Q

Lower body mass does what to creatinine clearance? GFR?

A

Lowers

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28
Q

What are the two ways to determine creatinine clearance?

A

Measure (24 hr urine collection)

Estimate (cockroft-gault equation)

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29
Q

Is an 8 hour creatinine clearance acceptable?

A

No

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30
Q

What is the equation for the cockroft gault equation?

A

[(Ideal weight)(140-age) / 72(serum Cr)] * 0.85 if female

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31
Q

In pts without a significant age related decline in renal function, is CrCl under or overestimeated?

A

Under

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32
Q

What is the major issue with Benzos?

A

Increases fall risk

33
Q

True or false: older pts may experience longer pain relief with morphine

A

True

34
Q

True or false: Benzos should not be used for sleep. Explain.

A

True–addicting

35
Q

What are the four factors that are needed for successful pharmacotherapy?

A

Correct drug, dose, condition

Is appropriate for pt

36
Q

ADEs are responsible for what percent of acute geriatric hospital admission?

A

5-28%

37
Q

What percent of ADEs occur in community dwelling older adults?

A

35%

38
Q

What are the most common drugs that cause ADEs? (5)

A 
Cardio
Diuretics
NSAIDs
Hypoglycemics
Anticoags
39
Q

What general characteristic of a drug is associated with ADEs?

A

Ones with narrow margin of safety

40
Q

What food is bad for CHF pts?

A

BBQ (salt)

41
Q

What percent of ambulatory adults receive at least one potentially inappropriate med?

A

> 20%

42
Q

What can underprescribing result from?

A

Assuming older adults will not benefit from

Meds intended as prim or sec prevention

Aggresive

43
Q

What is the most common drug that causes drowsiness?

A

Benadryl

44
Q

ACE inhibitors usually cause what?

A

Cough

45
Q

Long term beta blocker use can cause what?

A

Depression

46
Q

How many concurrent chronic conditions are a risk factor for ADEs?

A

6 or more

47
Q

How many doses of drugs/day are a risk factor for ADEs?

A

12 or more

48
Q

How many meds are a risk factor for ADEs?

A

9 or more

49
Q

True or false: prior adverse drug events are not a risk factor for ADEs

A

False

50
Q

What age is considered a risk factor for ADEs?

A

85+

51
Q

What is the CrCl that is a risk factor for ADEs?

A
52
Q

What are the most common drug-drug interactions?

A

Cardio and psychotropics

53
Q

What is the pathway that is utilized in drug metabolism?

A

CYP3A4 (p450)

54
Q

What are the symptoms of drug-drug interactions? (4)

A

Confusion/delirium
Cognitive impairment
Hypotension
Acute renal failure

55
Q

What should you consider before adding a drug?

A

Is this used to treat side effects of another drug?

56
Q

What are the two things that cause nonadherence to drugs?

A

Failure of dr to consider pts situation

Pts not understanding

57
Q

Over prescribed or under-prescribed: Antiinfective agents

A

Over

58
Q

Over prescribed or under-prescribed: anticholinergic agents

A

Over

59
Q

Over prescribed or under-prescribed: ACE inhibitors for pts with DM and proteinuria

A

Under

60
Q

Over prescribed or under-prescribed: angiotensin-receptor blockers

A

Under

61
Q

Over prescribed or under-prescribed: Urinary and GI antispasmodics

A

Over

62
Q

Over prescribed or under-prescribed: antipsychotics

A

Over

63
Q

Over prescribed or under-prescribed: Benzos

A

Over

64
Q

Over prescribed or under-prescribed: antigoagulants

A

Under

65
Q

Over prescribed or under-prescribed: antihypertensive agents and diuretics for uncontrolled HTN

A

Under

66
Q

Over prescribed or under-prescribed: digoxin for diastolic dysfuntion

A

Over

67
Q

Over prescribed or under-prescribed: dipyridamole

A

Over

68
Q

Over prescribed or under-prescribed: H2 receptor agonist

A

Over

69
Q

Over prescribed or under-prescribed: laxatives and fecal softeners

A

Over

70
Q

Over prescribed or under-prescribed: beta blocks for pts after an MI

A

Under

71
Q

Over prescribed or under-prescribed: bronchodilators

A

Under

72
Q

Over prescribed or under-prescribed: PPIs for GI protection from NSAIDs

A

Under

73
Q

Over prescribed or under-prescribed: statins

A

under

74
Q

Over prescribed or under-prescribed: NSAIDs

A

Over

75
Q

Over prescribed or under-prescribed: PPIs

A

Over

76
Q

Over prescribed or under-prescribed: Sedating antihistamines

A

Over

77
Q

Over prescribed or under-prescribed: TCAs

A

over

78
Q

Over prescribed or under-prescribed: vitamins and minerals

A

Over

79
Q

Over prescribed or under-prescribed: vitamin D

A

Under

Geriatrics (30 decks)

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