Pharmacotherapy in Older Adults Flashcards

1
Q

In the aging population, how does absorption change?

A

Doesn’t change

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2
Q

How does the peak serum concentration change in the older population?

A

Peak serum conc. may be lower and delayed

Exception: Drugs with extensive first-pass effect may increase because less drug is extracted by the liver which is smaller with reduced blood flow

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3
Q

What are the three factors that affect absorption?

A
  • Route of admin
  • Concurrent drugs
  • Comorbid illness
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4
Q

What are the effects of aging on volume of distribution?

A
  • Decreased body water - Lower VD for hydrophilic drugs
  • Decreased lead body mass - Lower VD for drugs that bind to muscle
  • Increased fat stores - Higher VD for lipophilic drugs
  • Decreased plasma protein - higher percentage of drug that is unbound
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5
Q

Factors causing decreased liver metabolism?

A
  • Aging decreases liver bloodflow, size, mass
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6
Q

What drugs based on metabolism are preferred in older patients? Why?

A

Phase II (conversion drugs to inactive metabolites) because active metabolites can be dangerous

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7
Q

Why are benzos highly contraindicated in elderly patients?

A

Benzos have highly active metabolites!

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8
Q

What common drug metabolized through hepatic metabolism should be avoided if possible?

A

NSAIDs

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9
Q

What organ eliminates most drugs from the body?

A

Kidneys

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10
Q

Why can kidney failure be problematic when dosing drugs?

A

Reduced kidney fuction = reduced elimination = drug accumulation and toxicity

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11
Q

General effects of aging on the kidney

A
  • Decreased kidney size
  • Decreased renal blood flow
  • Decreased number of functioning nephrons
  • Decreased renal tubular secretion

And therefore decreased GFR

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12
Q

What changes in serum creatinine occur with aging?

A

Lean body mass decreases resulting in lower creatinine production, BUT, GFR decreases too resulting in Cr in normal range

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13
Q

What is the usual method to measure Cr clearance?

A

Estimate using the Cockroft and Gault equation

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14
Q

What are pharmacodynamics?

A

Time course and intensity of pharmacologic effect of a drug

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15
Q

What are the four goals of a successful drug diagnosis?

A
  • Use the correct drug
  • Prescribe correct dosage
  • Target correct condition
  • Drug is appropriate for patient
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16
Q

What medications are most commonly associated with adverse drug interactions?

A
  • Cardiovascular meds
  • CNS
  • Musculoskeletal
  • Meds with narrow margin of saftey
17
Q

What are the RFs for ADEs?

A
  • 6 or more concurrent chronic conditions
  • 12 or more doses of drugs/day
  • 9 or more medications
  • Prior adverse drug rxn
  • Low body weight/BMI
  • > 85 yo
  • Cr clearance < 50 mL/min
18
Q

What is the ADE prescribing cascade?

A

Prescribing a drug and then prescribing another drug to Tx the previous drug’s SEs

19
Q

Factors that increase risk of drug-drug interactions?

A
  • Increased number of meds
  • Multiple prescribers
  • Multiple pharmacies
20
Q

What are some key facts about drug drug interaction?

A
  • Absorption can be up or down
  • Drugs with similar/opposite effects can have exaggerated/diminished effects
  • Metabolism may be inhibited/induced
  • Herbal preparations can fuck things up
21
Q

What are the most common adverse effects of drug-drug interaction?

A
  • Cognitive impairment
  • Confusion
  • Arterial hTN
  • ARF
22
Q

What are common drug-disease interactions?

A
  • Obesity alters VD of lipophilic drugs
  • Ascites alters VD of hydrophilic drugs
  • Dementia may increase sensitivity, induce paradoxical rxns to drugs with CNS or antiCh activity
  • Renal or hepatic impairment may impair detox and excretion of drugs
23
Q

What is the basic principle for dosing drugs?

A

Start low and go slow. Don’t start two drugs at once.