Pharmacology in Special Populations - Geriatrics

Question 1

What age is considered elderly in society and in medicine?

Answer 1

society = 65
medicine = 75

Question 2

Organ function declines progressively beginning around the (…) decade of life but seems to be dependent on overall “health”

Answer 2

3rd (in your thirties)

Question 3

In patients 65+ years old, glomerular function (…)

Answer 3

decreases

Question 4

Who will have better breathing capacities?

Answer 4

active, aerobic people

Question 5

What are some pharmacokinetic concepts you need to consider with geriatric patients?

Answer 5

• absorption
• distribution
• metabolism
• elimination

Question 6

In elderly patients, skin is (…)

Answer 6

thinner

Question 7

Elderly patients have (…) stomach acid

Answer 7

reduced

Question 8

Elderly patients have (…) gastric emptying, especially in diabetes

Answer 8

slower

Question 9

Elderly patients have changes in nutrition so they may not what?

Answer 9

be eating as much as you think

Question 10

Because skin is thinner in the elderly, absorption of drugs may be (…)

Answer 10

quicker and will absorb more medications in the skin

Question 11

Because stomach acid(pH) is reduced in elderly patients, what may happen?

Answer 11

pts may experience higher peak plasma concentrations

Question 12

Because gastric emptying is slower in elderly patients, what may happen?

Answer 12

drugs will sit in the stomach longer, decreasing the rate of absorption

Question 13

Elderly patients have (1) muscle mass and (2) body fat percentage

Answer 13

1. less
2. greater

Question 14

Elderly patients have (1) albumin and (2) alpha-acid glycoprotein

Answer 14

1. lower
2. higher

Question 15

Elderly patients have (…) body water

Answer 15

lower

Question 16

Having a higher alpha-acid glycoprotein can increase what?

Answer 16

protein binding

Question 17

Low nutrition and reduced liver function leads to (…)

Answer 17

lower albumin

Question 18

Less muscle mass, greater body fat percentage, albumin levels, glycoprotein levels, and body water all affects what?

Answer 18

volume of distribution

Question 19

Does low albumin levels increase or decrease volume of distribution?

Answer 19

increase

Question 20

Does lower body water increase of decrease volume of distribution?

Answer 20

decrease

Question 21

Does less muscle mass increase or decrease volume of distribution?

Answer 21

decrease

Question 22

In elderly patients, blood flow to the liver (…), which is exacerbated by congestive heart failure

Answer 22

decreases

Question 23

Decreases in blood flow to the liver as you get older can lead to drugs doing what?

Answer 23

not moving through the body well

Question 24

In elderly patients, phase I reactions (…)

Answer 24

decrease

Question 25

What may be present in elderly patients and is important in metabolism of drugs even if resolved because there may still be residual damage?

Answer 25

liver damage

Question 26

What may malnutrition affect in elderly patients?

Answer 26

drug metabolism

Question 27

What are 3 ways that drug elimination is affected in elderly patients?

Answer 27

1. decrease in GFR 2. dehydration 3. reduced lung capacity

Question 28

A decrease in GFR may indicate what?

Answer 28

the kidneys are not functioning as they should (decrease in functionality)

Question 29

How does dehydration affect drug elimination?

Answer 29

decreases drug elimination

Question 30

Reduced lung capacity and prevalence of pulmonary disease limit what?

Answer 30

the use of inhaled anesthetics

Question 31

Almost all elderly pts have some form of (...)

Answer 31

diabetes

Question 32

What are 4 additional drug problems that elderly patients may have to deal with?

Answer 32

1. multiple drugs, multiple doctors 2. cost 3. access to care 4. physical problems leading to inability to use medications properly

Question 33

What may multiple drugs and multiple doctors lead to in elderly patients?

Answer 33

- side effects - interactions - poor compliance - duplicate therapies

Question 34

"New" symptoms in older adults should be considered a (...) and a thorough drug history should be obtained and sorted through

Answer 34

medication side effect

Question 35

Patients in a facility where drugs are administered to them may have what happen to them?

Answer 35

may not be receiving their medications on time

Question 36

"Child proof" medication bottles might also be what?

Answer 36

elder proof

Question 37

What are some ways in which physical problems may lead to elderly patients not using medications properly?

Answer 37

- may not be able to open containers - may get confused which pill is which - may take pill at wrong time, thinking it is something else

Question 38

What is Beers Criteria for potentially inappropriate medication use in older patients?

Answer 38

- list of drugs to avoid or use with caution in patients over 65

Question 39

What does Beers Criteria not apply to?

Answer 39

hospice or palliative care

Question 40

Beers Criteria's concerns often apply to?

Answer 40

- fall risks - seizure risks - cognitive impairment - renal function

Question 41

What are some strategies to improve therapeutic outcomes in older adults?

Answer 41

- thorough drug history - watch off-label prescribing - start low and go slow - know your side effects and drug interactions - use simple regimens - make sure the patient understands the directs and is able to follow them - consider expected life span of patient - discuss patient goals and willingness to comply

Question 42

What is off-label prescribing?

Answer 42

prescribing a drug for a different purpose than what the FDA approved

Question 43

Why would you start at a low dose and go slow in treating elderly patients?

Answer 43

you want to make sure drugs work well and don't have side-effects **wait 3 half-lives, maybe 5 in elderly**

Question 44

Why should you consider expected life span of a patient when prescribing medications?

Answer 44

quality of life matters, medications may decrease the quality of life, so patient may not want to take the medication