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3MB Ageing > Pharmacology of Old Age > Flashcards

Pharmacology of Old Age Flashcards

1
Q

What is meant by Pharmacokinetics?

A

The movement of a drug through the body

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2
Q

What are the principles of pharmacokinetics?

A

Absorption
Distribution
Metabolism
Excretion

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3
Q

Which is the most important principle of pharmacokinetics?

A

Metabolism, as the way young people and the elderly metabolise substances differs.

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4
Q

Is age the sole factor for creating changes in medications?

A

No, must consider other factors too e.g. comorbidities which have to be comanaged.

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5
Q

What are the 2 principles of absorption?

A
  1. Basic environments absorb basic drugs e.g. diazepam, morphine
  2. Acidic environments absorb acidic drugs e.g. aspirin
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6
Q

Which drugs decrease stomach acidity and therefore, acidic drug absorption?

A

PPIs

H2 Receptor Antagonists

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7
Q

What happens to body pH with increasing age?

A

Decreases, so the body environment becomes more acidic and cannot absorb basic drugs as well

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8
Q

What happens to the bowels with increasing age?

A

Decreases in surface area, slowing drug absorption

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9
Q

What is meant by drug distribution?

A

The proportion of free drug vs. drug bound to protein

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10
Q

What are the principles distribution?

A

Basic proteins e.g. Albumin, carry acidic drugs

Acidic proteins e.g. Alpha 1 Acid Glycoprotein, carry basic drugs

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11
Q

What happens to carrier proteins with increasing age?

A

Albumin levels decrease and alpha 1 acid glycoprotein levels increase meaning that basic drug remains unabsorbed in the body longer, increasing risk of delirium or confusion.

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12
Q

What is meant by the volume of distribution (VoD)?

A

Theoretical volume which will contain the total amount of the administered drug at the same concentration as that of blood plasma

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13
Q

What happens to the proportion of fat and muscle tissue in elderly people?
What does this mean?

A

Greater proportion of fat tissue to muscle mass.

This means that lipophilic drugs will have a higher VoD as it will be contained within the increased fatty tissue.

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14
Q

In elderly patients, what does the VoD of a drug help to show in terms of drug characteristics?

A

The lipid solubility and half-life.

The higher the VoD, the higher the lipid solubility and the longer the half-life.

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15
Q

What is the half-life of a drug directly proportional to?

A

The VoD of the drug

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16
Q

What is the half-life of a drug inversely proportional to?

A

The hepatic/renal clearance

17
Q

Why is hepatic metabolism slowed with increasing age?

A

Decreased liver size
Illness
Decreased hepatic blood flow

18
Q

Why is renal metabolism slowed with increasing age?

A

Decreased kidney sizes.
Reduced GFR
Reduced tubular secretion
Reduced renal blood flow

19
Q

What is the problem with lipophilic drugs in the elderly?

A

If the patient undergoes cachexia, fatty tissues will break down, releasing the lipophilic protein into the body, resulting in potential delirium or confusion.

20
Q

Are hydrophilic drugs well-absorbed in the elderly?

A

Not as well as lipophilic drugs due to age-related loss of water content in the body.

21
Q

What are bio-transforming enzymes?

Do they increase/decrease with age?

A

Proteins which alter a substance.

Decrease with age.

22
Q

What is meant by pharmacodynamics?

A

How the body responds to a drug?

23
Q

What is the general principle of pharmacodynamics in the elderly?

A

A lower dose of the drug will have the SAME effect as normal dosage in a young person

24
Q

What happens to the therapeutic window with increasing age? What does this mean?

A

Therapeutic window narrows with age.

This means that toxic responses to drugs increases while therapeutic responses decrease.

25
Q

How is the therapeutic index of a drug calculated?

A

Minimum toxic dose/Minimum effective dose

26
Q

Which drugs have a low therapeutic index (<2)?

A
  1. Warfarin
  2. Digoxin
  3. Lithium
  4. Benzodiazepines
27
Q

Give an example of prophylaxis for an adverse drug effect:

A

Laxatives for opioid-induced constipation
Vitamin D/Calcium for steroid-induced osteoporosis
Regular blood glucose check for steroid-induced diabetes

28
Q

Give an example of adverse drug reactions that result from drug interactions:

A

Calcium slowing down Levothyroxine absorption (therefore, take levothyroxine in the morning and calcium in the evening)

Beta blockers with Verapamil/Diltiazem causing bradycardia

29
Q

What is important to remember with antibiotics in the elderly?

A

They must be targeted and given in cases of definite infection.

(due to increased risk of resistance, C.Diff and renal impairment)

30
Q

What are adverse effects of NSAIDs?

A

Renal impairment
GI bleed
Reduced diuretic effect due to increased sodium reabsorption

31
Q

What can be done to as prophylaxis for NSAID adverse effects?

A

Prescribe paracetamol for patients with mild, non-OA pain

Use less potent NSAIDs in patients with CVD e.g. Ibuprofen instead of Diclofenac

32
Q

What are adverse effects of opiates?

A

Psychomotor impairment
Falls
Delirium
Confusion

33
Q

Why is polypharmacy important?

A

Patients more likely to suffer from adverse drug effects as multiple drugs means increased risk of interactions

34
Q

Why are over-the-counter medications important?

A

They can interact with prescribed medications

35
Q

What can be done to counteract issues in polypharmacy?

A

Prescribe 1 drug that can target 1+ problems
Use combination treatments to ease pill burden
Do NOT counter the adverse effect of one drug by prescribing another drug - reduce dose of initial drug or choose alternative

36
Q

Which screening tools can be used to avoid certain medications in the elderly but alert to appropriate ones?

A 
BEER Criteria (American Geriatric Society)
STOP START Tool

3MB Ageing (8 decks)

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