Pharmacology Considerations in Gerontology Flashcards
__________: Study of how the body interacts with drugs, including absorption, distribution, metabolism and excretion
Pharmacokinetics
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 ______.
antacid
b. Instruct patients to take antacids ___ hour before or 4 hours after other medications
1
a. Distribution is unaffected unless the patient is
affected by serious ______ disease
cardiovascular
b. _________ = dose/volume of distribution
Concentration
Distribution
c. Free drug in ________; target site availability; tissue storage
circulation
- Distribution
d. Fluid and tissue compartments
i) ______ in total body water
Decrease
- Distribution
d. Fluid and tissue compartments
ii) _______ in fat
Increase
- Distribution
d. Fluid and tissue compartments
iii) _______ in muscle mass
Decrease
- Distribution
e. Plasma drug-binding proteins
i) Decrease in serum _____ levels
albumin
a. Metabolism may be significantly reduced in the geriatric patient, particularly if there is any _____impairment. Dosage adjustments may be necessary.
liver
Metabolism:
i) Natural decrease in hepatic ___ ____; often
associated with potential decreased first pass effects
blood flow
- 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.
reduced
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
Decreased
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
Decreased
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
Decreased
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
Decline
__________: Study of how drugs interact with the body
Pharmacodvnamics
Pharmacodynamics:
- Receptor changes
a. Receptors may up-regulate or down-regulate with age, causing an increased or decreased ____ to certain agents.
sensitivity
Pharmacodynamics:
- __________ changes
a. Decreased capacity to respond to physiological challenges and the adverse side effects of drug therapy (e.g., orthostatic hypotension)
Homeostasis
___________: 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.
Pharmacogenetics
__________:
- 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
Pharmacogenetics
- __________ begins with an unexpected drug response, and then searches for a genetic cause.
Pharmacogenetics
- __________ begins with looking for genetic differences within a population that explain certain observed responses to a drug.
Pharmacogenomics
Adverse Reactions
1. Common adverse reactions seenin the elderly
a. Central nervous system effects:
i) Sedation
ii) \_\_\_\_ \_\_\_\_
iii) Dizziness
iv) Depression
v) ConfusionMemory loss
Adverse Reactions b. Anticholinergic effects: i) Blurred vision ii) Urinary retention iii) \_\_\_\_\_\_\_\_ iv) Drymouth
Constipation
Adverse Reactions
c. Effects on ______ and balance
movement
Adverse Reactions
d. Effects on _____ and supporting structures
bone’s
- 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
Antipsychotics
- Drags most likely to cause adverse effects in the geriatric patient
b. Those with anticholinergic adverse effects
i) Cholinergic agonists
ii) ____ antidepressants
iii) Antipsychotics
Tricyclic
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) AminoglycosidesBeta-blockers
Adverse Reactions: d. Those with adverse effects on bone and supporting structures i) Steroids ii) \_\_\_\_\_\_ iii) Lithium
Heparin
Promoting Safe Drug Use
1. The literature evidences that non-adherence to drug regimens is noted to be approximately __% among older adults.
45
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.
12
Promoting Safe Drug Use
b. Geriatric patients take more ___-___ ___ drugs
than any other age group.
over-the-counter
Promoting Safe Drug Use
- Recognize that self-medication may be a problem
a. The patient may be using medicine that belongs to
____ ____.
someone else
Promoting Safe Drug Use
b. The patient may be using alternative or herbal
medications or therapies that may interact _____
with prescription medicines.
adversely
Promoting Safe Drug Use
- Provide education and a _______ if a prescription drug is not indicated, as well as if one is indicated.
rationale
Promoting Safe Drug Use
- ____ ____ ___ (e.g., Mini-Mental State Examination, Geriatric Depression Screen) may be good indicators of whether a patient can manage a medication regimen.
Functional assessment tools
_____ in the Elderly
1. The use of more medicines than are clinically indicated
Polypharmacy
Polypharmacy in the Elderly
- Commonly seen in the geriatric patient due-to-several factors that promote polypharmacy
a. The presence of _____ conditions
comorbid
Polypharmacy in the Elderly
- Commonly seen in the geriatric patient due-to-several factors that promote polypharmacy
b. Use of multiple _____
prescribers
Polypharmacy in the Elderly
- Commonly seen in the geriatric patient due-to-several factors that promote polypharmacy
c. Overuse of ____-____ and alternative
medicines
non-prescription
Polypharmacy in the Elderly
- Commonly seen in the geriatric patient due-to-several factors that promote polypharmacy
d. Prevalence of the concept of a “____ ____ every ill”
pill for
Polypharmacy in the Elderly
- Prevention of polypharmacy
a. Recognition of the problem
i) Clinical consult with a ______ may be helpful
pharmacist
Polypharmacy in the Elderly
- Prevention of polypharmacy
a. Recognition of the problem
ii) “____ _____” approach, where all medications
the patient Is currently taking are brought in is
useful
Brown bag
Polypharmacy in the Elderly
3. Prevention of polypharmacy
b. Education of the patient
i) Include discussion of all over-the-counter and
\_\_\_\_\_ medicationsherbal
Polypharmacy in the Elderly
3. Prevention of polypharmacy
c. Communication between pharmacists and
prescribers is key
i) “______ medicines only approach
Essential
Polypharmacy in the Elderly
- Prevention of polypharmacy
d. Avoid ______ products
combination
Polypharmacy in the Elderly
- Prevention of polypharmacy
e. Start with ______ effective doses
lowest
- Risks associated with polypharmacy
a. Increased:
i) Morbidity
ii) Medical expense
iii) Adverse reactions
iv) Incidence of ________
v) Risk of nursing home placement
depression
- Over-the-counter agents that complicate polypharmacy
a. _______: Inhibits cytochrome P450 in the liver,
prolonging the effects of other drugs in the body
Cimetidine
- Over-the-counter agents that complicate polypharmacy
b. ________: Antagonize the activity of
antihypertensives; are anticholinergic
Decongestants
- Over-the-counter agents that complicate polypharmacy
c. ____ ____ ____ ____ ___:
Decrease renal blood flow, further reducing elimination of many drugs
Non-steroidal anti-inflammatory drugs (NSAIDs)
- Over-the-counter agents that complicate polypharmacy
d. _____: May exacerbate the effect of antihypertensives
Niacin
- Over-the-counter agents that complicate polypharmacy
e. ______: May adsorb other oral agents, reducing their absorbance across the gut wall
Antacids
- Over-the-counter agents that complicate polypharmacy
f. Laxatives:
i) May ____ other drugs so they cannot be absorbed
chelate
- Over-the-counter agents that complicate polypharmacy
f. Laxatives:
ii) May ______ gut motility
increase
- Over-the-counter agents that complicate polypharmacy
f. Laxatives:
iii) May reduce ______ of some drugs.
absorbance
- Over-the-counter agents that complicate polypharmacy
g. Calcium products:
i) May _______ absorbance of thyroid hormones
decrease
- Over-the-counter agents that complicate polypharmacy
g. Calcium products:
ii) T________
tetracycline
- _______ agents that complicate polypharmacy
Herbal
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.
40%
Comorbidity influences of medication use
1. Renal disease
b. Renal disease would further impact this, affecting
drug _______.
elimination
Comorbidity influences of medication use
1. Renal disease
c. Dosage adjustments should be made usually based
on ______ clearance.
creatinine
Comorbidity influences of medication use
2. Hepatic disease
a. ______, cirrhosis, or liver impairment affects
hepatic metabolism of most drugs.
Hepatitis
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.
higher
Comorbidity influences of medication use
3. Cardiac disease
a. Heart failure may affect perfusion of tissues and
____ _____, leading to less than optimal therapeutic
outcomes.
drag delivery
