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Primary > Pharmacology Considerations in Gerontology > Flashcards

Pharmacology Considerations in Gerontology Flashcards

1
Q

__________: Study of how the body interacts with drugs, including absorption, distribution, metabolism and excretion

A

Pharmacokinetics

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2
Q

a. For most of the drugs taken by the elderly,
absorption is unaffected unless the patient takes the
medication with an adsorbent, such as an ______.

A

antacid

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3
Q

b. Instruct patients to take antacids ___ hour before or 4 hours after other medications

A

1

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4
Q

a. Distribution is unaffected unless the patient is

affected by serious ______ disease

A

cardiovascular

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5
Q

b. _________ = dose/volume of distribution

A

Concentration

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6
Q

Distribution

c. Free drug in ________; target site availability; tissue storage

A

circulation

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7
Q
  1. Distribution
    d. Fluid and tissue compartments
    • i) ______ in total body water
A

Decrease

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8
Q
  1. Distribution
    d. Fluid and tissue compartments
    • ii) _______ in fat
A

Increase

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9
Q
  1. Distribution
    d. Fluid and tissue compartments
    • • iii) _______ in muscle mass
A

Decrease

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10
Q
  1. Distribution
    e. Plasma drug-binding proteins
    • i) Decrease in serum _____ levels
A

albumin

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11
Q

a. Metabolism may be significantly reduced in the geriatric patient, particularly if there is any _____impairment. Dosage adjustments may be necessary.

A

liver

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12
Q

Metabolism:
i) Natural decrease in hepatic ___ ____; often
associated with potential decreased first pass effects

A

blood flow

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13
Q
  1. Elimination
    a. Renal clearance is significantly ______ in older adults. As a result, many drugs can be therapeutic at dosages lower than prescribed for a younger adult. Consider a lower dosage and consult a geriatric dosage handbook for accurate dosing in the geriatric patient.
A

reduced

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14
Q

b. In the patient with renal insufficiency, drug dosages may be significantly reduced.
Renal function must be monitored to both prescribe the appropriate dose and assesses for adverse reactions. Thus, drug elimination changes in the elderly are due to overall, decreased renal function.
• i) _____ blood flow to the kidneys

A

Decreased

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15
Q

b. In the patient with renal insufficiency, drug dosages may be significantly reduced.
Renal function must be monitored to both prescribe the appropriate dose and assesses for adverse reactions. Thus, drug elimination changes in the elderly are due to overall, decreased renal function.
• ii) _____ glomerular filtration

A

Decreased

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16
Q

b. In the patient with renal insufficiency, drug dosages may be significantly reduced.
Renal function must be monitored to both prescribe the appropriate dose and assesses for adverse reactions. Thus, drug elimination changes in the elderly are due to overall, decreased renal function.
• iii) _______ tubular secretion

A

Decreased

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17
Q

b. In the patient with renal insufficiency, drug dosages may be significantly reduced.
Renal function must be monitored to both prescribe the appropriate dose and assesses for adverse reactions. Thus, drug elimination changes in the elderly are due to overall, decreased renal function.
• iv) _____ in creatinine clearance

A

Decline

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18
Q

__________: Study of how drugs interact with the body

A

Pharmacodvnamics

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19
Q

Pharmacodynamics:

  1. Receptor changes
    a. Receptors may up-regulate or down-regulate with age, causing an increased or decreased ____ to certain agents.
A

sensitivity

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20
Q

Pharmacodynamics:

  1. __________ changes
    a. Decreased capacity to respond to physiological challenges and the adverse side effects of drug therapy (e.g., orthostatic hypotension)
A

Homeostasis

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21
Q

___________: Study of single-gene genetic variations in drug variations
1. The goal of pharmacogenetics is to understand the role that an individual’s genetic makeup plays in how well a medication works, including any likely side effects.

A

Pharmacogenetics

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22
Q

__________:

  1. Benefits
    a. Development of drugs that maximize therapeutic effects
    b. More accurate methods of determining dosages
    c. Drugs that are prescribed specifically for a patient’s genetic profile
A

Pharmacogenetics

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23
Q
  1. __________ begins with an unexpected drug response, and then searches for a genetic cause.
A

Pharmacogenetics

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24
Q
  1. __________ begins with looking for genetic differences within a population that explain certain observed responses to a drug.
A

Pharmacogenomics

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25
Q 
Adverse Reactions
1. Common adverse reactions seenin the elderly
     a. Central nervous system effects:
•        i) Sedation •
         ii) \_\_\_\_ \_\_\_\_
        iii) Dizziness
        iv) Depression 
         v) Confusion
A

Memory loss

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26
Q 
Adverse Reactions
 b. Anticholinergic effects:
•      i) Blurred vision
•     ii) Urinary retention
•    iii) \_\_\_\_\_\_\_\_
•    iv) Drymouth
A

Constipation

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27
Q

Adverse Reactions

c. Effects on ______ and balance

A

movement

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28
Q

Adverse Reactions

d. Effects on _____ and supporting structures

A

bone’s

29
Q
  1. Drags most likely to cause adverse effects in the geriatric patient
    a. Those with central nervous system adverse effects •
    i) Benzodiazepines
    • • ii) ________
    • • iii) Beta-blockers
    • • iv) Steroids
    v) Cimetidine
    vi) Narcotics
    vii) Diuretics
A

Antipsychotics

30
Q
  1. Drags most likely to cause adverse effects in the geriatric patient
    b. Those with anticholinergic adverse effects
    • i) Cholinergic agonists
    • ii) ____ antidepressants
    • iii) Antipsychotics
A

Tricyclic

31
Q 
Adverse Reactions: 
c. Those with adverse effects on balance and movement
•    i) Neuroleptics
     ii) Furosemide •
    iii) Metronidazole
    iv) \_\_\_\_- \_\_\_\_•
     v) Phenytoin
•  vi) Vasodilators •
   vii) Aspirin
•viii) Metoclopramide •
    ix) Aminoglycosides
A

Beta-blockers

32
Q 
Adverse Reactions: 
d. Those with adverse effects on bone and supporting structures
•    i) Steroids
•   ii) \_\_\_\_\_\_
•  iii) Lithium
A

Heparin

33
Q

Promoting Safe Drug Use

1. The literature evidences that non-adherence to drug regimens is noted to be approximately __% among older adults.

A

45

34
Q

Promoting Safe Drug Use
2. Recognize that patients are usually on multiple medications
a. According to the Centers for Disease Control, elders
with multiple diseases can easily take up to ___
different prescriptions medications every day.

A

12

35
Q

Promoting Safe Drug Use
b. Geriatric patients take more ___-___ ___ drugs
than any other age group.

A

over-the-counter

36
Q

Promoting Safe Drug Use

  1. Recognize that self-medication may be a problem
    a. The patient may be using medicine that belongs to
    ____ ____.
A

someone else

37
Q

Promoting Safe Drug Use

b. The patient may be using alternative or herbal
medications or therapies that may interact _____
with prescription medicines.

A

adversely

38
Q

Promoting Safe Drug Use

  1. Provide education and a _______ if a prescription drug is not indicated, as well as if one is indicated.
A

rationale

39
Q

Promoting Safe Drug Use

  1. ____ ____ ___ (e.g., Mini-Mental State Examination, Geriatric Depression Screen) may be good indicators of whether a patient can manage a medication regimen.
A

Functional assessment tools

40
Q

_____ in the Elderly

1. The use of more medicines than are clinically indicated

A

Polypharmacy

41
Q

Polypharmacy in the Elderly

  1. Commonly seen in the geriatric patient due-to-several factors that promote polypharmacy
    a. The presence of _____ conditions
A

comorbid

42
Q

Polypharmacy in the Elderly

  1. Commonly seen in the geriatric patient due-to-several factors that promote polypharmacy
    b. Use of multiple _____
A

prescribers

43
Q

Polypharmacy in the Elderly

  1. Commonly seen in the geriatric patient due-to-several factors that promote polypharmacy
    c. Overuse of ____-____ and alternative
    medicines
A

non-prescription

44
Q

Polypharmacy in the Elderly

  1. Commonly seen in the geriatric patient due-to-several factors that promote polypharmacy
    d. Prevalence of the concept of a “____ ____ every ill”
A

pill for

45
Q

Polypharmacy in the Elderly

  1. Prevention of polypharmacy
    a. Recognition of the problem
    • i) Clinical consult with a ______ may be helpful
A

pharmacist

46
Q

Polypharmacy in the Elderly

  1. Prevention of polypharmacy
    a. Recognition of the problem
    • ii) “____ _____” approach, where all medications
    the patient Is currently taking are brought in is
    useful
A

Brown bag

47
Q 
Polypharmacy in the Elderly
3. Prevention of polypharmacy
    b. Education of the patient
•       i) Include discussion of all over-the-counter and 
            \_\_\_\_\_ medications
A

herbal

48
Q

Polypharmacy in the Elderly
3. Prevention of polypharmacy
c. Communication between pharmacists and
prescribers is key
i) “______ medicines only approach

A

Essential

49
Q

Polypharmacy in the Elderly

  1. Prevention of polypharmacy
    d. Avoid ______ products
A

combination

50
Q

Polypharmacy in the Elderly

  1. Prevention of polypharmacy
    e. Start with ______ effective doses
A

lowest

51
Q
  1. Risks associated with polypharmacy
    a. Increased:
    • i) Morbidity
    • ii) Medical expense •
    iii) Adverse reactions •
    iv) Incidence of ________•
    v) Risk of nursing home placement
A

depression

52
Q
  1. Over-the-counter agents that complicate polypharmacy
    a. _______: Inhibits cytochrome P450 in the liver,
    prolonging the effects of other drugs in the body
A

Cimetidine

53
Q
  1. Over-the-counter agents that complicate polypharmacy
    b. ________: Antagonize the activity of
    antihypertensives; are anticholinergic
A

Decongestants

54
Q
  1. Over-the-counter agents that complicate polypharmacy
    c. ____ ____ ____ ____ ___:
    Decrease renal blood flow, further reducing elimination of many drugs
A

Non-steroidal anti-inflammatory drugs (NSAIDs)

55
Q
  1. Over-the-counter agents that complicate polypharmacy

d. _____: May exacerbate the effect of antihypertensives

A

Niacin

56
Q
  1. Over-the-counter agents that complicate polypharmacy

e. ______: May adsorb other oral agents, reducing their absorbance across the gut wall

A

Antacids

57
Q
  1. Over-the-counter agents that complicate polypharmacy
    f. Laxatives:
    • i) May ____ other drugs so they cannot be absorbed
A

chelate

58
Q
  1. Over-the-counter agents that complicate polypharmacy
    f. Laxatives:
    • ii) May ______ gut motility•
A

increase

59
Q
  1. Over-the-counter agents that complicate polypharmacy
    f. Laxatives:
    • iii) May reduce ______ of some drugs.
A

absorbance

60
Q
  1. Over-the-counter agents that complicate polypharmacy
    g. Calcium products:
    • i) May _______ absorbance of thyroid hormones
A

decrease

61
Q
  1. Over-the-counter agents that complicate polypharmacy
    g. Calcium products:
    • ii) T________
A

tetracycline

62
Q
  1. _______ agents that complicate polypharmacy
A

Herbal

63
Q

Comorbidity influences of medication use
1. Renal disease
a. In the healthy adult, renal function may be reduced
as much as ___% by the elder years.

A

40%

64
Q

Comorbidity influences of medication use
1. Renal disease
b. Renal disease would further impact this, affecting
drug _______.

A

elimination

65
Q

Comorbidity influences of medication use
1. Renal disease
c. Dosage adjustments should be made usually based
on ______ clearance.

A

creatinine

66
Q

Comorbidity influences of medication use
2. Hepatic disease
a. ______, cirrhosis, or liver impairment affects
hepatic metabolism of most drugs.

A

Hepatitis

67
Q

Comorbidity influences of medication use
2. Hepatic disease
b. As a result, serum levels of drugs may be _____,
and dosages need to be adjusted accordingly.

A

higher

68
Q

Comorbidity influences of medication use
3. Cardiac disease
a. Heart failure may affect perfusion of tissues and
____ _____, leading to less than optimal therapeutic
outcomes.

A

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