Polypharm overview Flashcards
decreases in asbsorption with age
decreased small bowel surface area
slowed gastric empything
increased gastric pH
rates of drug metabolism have what type variability
person to person
drugs with what conjugation don’t have an affected clearance
glucuronic acid
what kidney test should be used to evaluate kidney function
BUN
if a patient is taing a benzo what should you make sure they aren’t taking?
kava
what may valerin affect?
sedatives
Decrease in distribution reasons
Decrease in lean body mass (muscle) & increase in total body fat
Decrease in total body water
Decrease in serum albumin
Changes in metabolism with age
Liver mass & hepatic blood flow decrease
Decreased first pass metabolism
Rates of drug metabolism have person-to-person variability
Multistage metabolic clearance likely more prolonged
Drugs w/glucuronic acid conjugation - clearance not affected
Changes in elimination with age
Age related decrease creatinine clearance varies person-to-person
Dynamics renal vs. systemic clearance & drug’s maximum tolerated dose vs. minimum effective dose
What are 3 drugs that old people are on in nursing home?
atypical antipsychotics
warfarin
sedative-hypnotics
What are 3 drugs that old people are on in community dwelling?
Anti-DM
NSAIDs
Benzodiapines
May - intensify/prolong sedatives; reduce iron absorption, increase bleeding risk/warfarin d/t phytocoumarins
Chamomile
May – potentiate drugs /cytochrome P-450 (amiodarone, methotrexate)/monitor LFTs
Echinacea
May – additive vaso-constrictive effects; inhibit platelet aggregation/additive effect, reduce iron absorption, additive effect/warfarin
Feverfew
May – inhibit platelet aggregation & fibrinolytic effect, augment Warfarin’s effect, augment anti-HTN meds
Garlic
May - inhibit platelet aggregation, augment Warfarin’s effect
Ginger
May – decrease efficacy anticonvulsants d/t contaminants, augment inhibition platelet aggregation/NSAIDS, augment Warfarin’s effect
Gingko
May – intensify anti-DM agents (glipizide), augment ASA/platelet aggregation inhibition, intensify steroid effects d/t anti-inflammatory properties, increase digoxin levels, reduce effectiveness opioids, augment Warfarin effects
Ginseng
Augment effects sedatives (benzodiazepines)
Kava
May – reduce effect/digoxin, reduce iron absorption, increase photosensitivity, augment SSRIs, TCAs, reduce Warfarin level
St. John’s Wort
Augment effects sedatives
Valerian
______ is least affected by age
Absorption
What are 3 non age related effects on excretion that should also be considered in elderly?
hydration
CO
intrinsic renal disease
Pharmacodynamic Changes
Age-related changes in tissue sensitivity that affect responsiveness to drug concentrations
What is the confusion assessment method?
Used to screen for delirium
Administered in <5 minutes
Does not assess severity or cause
What are the 4 features of CAM that are found to have greatest ability to distinguish delirium from other types of cognitive impairment?
Acute Onset
Inattention
Disorganized thinking
Altered LOC
Diagnosis of delirium needs 1 and 2 with either 3 or 4
