Polypharm overview

Question 1

decreases in asbsorption with age

Answer 1

decreased small bowel surface area
slowed gastric empything
increased gastric pH

Question 2

rates of drug metabolism have what type variability

Answer 2

person to person

Question 3

drugs with what conjugation don’t have an affected clearance

Answer 3

glucuronic acid

Question 4

what kidney test should be used to evaluate kidney function

Answer 4

BUN

Question 5

if a patient is taing a benzo what should you make sure they aren’t taking?

Answer 5

kava

Question 6

what may valerin affect?

Answer 6

sedatives

Question 7

Decrease in distribution reasons

Answer 7

Decrease in lean body mass (muscle) & increase in total body fat
Decrease in total body water
Decrease in serum albumin

Question 8

Changes in metabolism with age

Answer 8

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

Question 9

Changes in elimination with age

Answer 9

Age related decrease creatinine clearance varies person-to-person
Dynamics renal vs. systemic clearance & drug’s maximum tolerated dose vs. minimum effective dose

Question 10

What are 3 drugs that old people are on in nursing home?

Answer 10

atypical antipsychotics
warfarin
sedative-hypnotics

Question 11

What are 3 drugs that old people are on in community dwelling?

Answer 11

Anti-DM
NSAIDs
Benzodiapines

Question 12

May - intensify/prolong sedatives; reduce iron absorption, increase bleeding risk/warfarin d/t phytocoumarins

Answer 12

Chamomile

Question 13

May – potentiate drugs /cytochrome P-450 (amiodarone, methotrexate)/monitor LFTs

Answer 13

Echinacea

Question 14

May – additive vaso-constrictive effects; inhibit platelet aggregation/additive effect, reduce iron absorption, additive effect/warfarin

Answer 14

Feverfew

Question 15

May – inhibit platelet aggregation & fibrinolytic effect, augment Warfarin’s effect, augment anti-HTN meds

Answer 15

Garlic

Question 16

May - inhibit platelet aggregation, augment Warfarin’s effect

Answer 16

Ginger

Question 17

May – decrease efficacy anticonvulsants d/t contaminants, augment inhibition platelet aggregation/NSAIDS, augment Warfarin’s effect

Answer 17

Gingko

Question 18

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

Answer 18

Ginseng

Question 19

Augment effects sedatives (benzodiazepines)

Answer 19

Kava

Question 20

May – reduce effect/digoxin, reduce iron absorption, increase photosensitivity, augment SSRIs, TCAs, reduce Warfarin level

Answer 20

St. John’s Wort

Question 21

Augment effects sedatives

Answer 21

Valerian

Question 22

______ is least affected by age

Answer 22

Absorption

Question 23

What are 3 non age related effects on excretion that should also be considered in elderly?

Answer 23

hydration
CO
intrinsic renal disease

Question 24

Pharmacodynamic Changes

Answer 24

Age-related changes in tissue sensitivity that affect responsiveness to drug concentrations

Question 25

What is the confusion assessment method?

Answer 25

Used to screen for delirium
Administered in <5 minutes
Does not assess severity or cause

Question 26

What are the 4 features of CAM that are found to have greatest ability to distinguish delirium from other types of cognitive impairment?

Answer 26

Acute Onset
Inattention
Disorganized thinking
Altered LOC

Diagnosis of delirium needs 1 and 2 with either 3 or 4