Population-specific considerations in drug therapy (part 2) Flashcards
older adults/elderly are commonly referred to as what age???
65 and older
“young-old”
65-74
“old-old”
75-84
“very-old-old”
85+
currently, how many million individuals are greater than 65 in the US
greater than 54 million
by 2030, nearly __ in 5 residents is expected to be >65
1 in 5
what is the most RAPIDLY GROWING AGE GROUP
seniors 85 and older
name 6 reasons as to why older adults are at risk for medication-related problems
-comorbidities
-multiple prescribers/sites of care
-multiple pharmacies/medication sources
-use of many medications (called polypharmacy)
-patient nonadherence
-inadequate pt education on RX and OTC
true or false
pharmacokinetics and pharmacodynamics have relatively the same predictability as we age
false – more viariable and unpredicatable. organ function changes
what does the cockcroft-gault equation measure?
creatinine levels — kidney function
true or false
pharmodynamics are not as well understood as pharmokinetics
true
in the elderly, what changes are seen in regards to pharmodynamics?
change in # of receptors, sensitivity of receptors, and counter regulatory mechanisms
when dosing in older adults, what motto should you follow
“start low and go slow”
when should you avoid prescribing estended released products?
if pts cannot swallow a whole tablet and need to have meds crushed (dysphagia = difficulty swallowing)
Name 3 types of absorption that are affected by age
Gastrointestinal
Intramuscular
Transdermal
Gastrointestinal is delayed but its not significant
Intramuscular is delayed
Transdermal is possible decrease
In the elderly, there is a larger _____ for fat soluble meds
Vd — volume distribution
With age, albumin goes up or down? What about free fraction? What pharmacokinetic property is this related to?
Albumin Dow, free fraction up
Distribution
True or false
With age, some metabolic. Pathways decline
True
What is the concern about “elimination” as we age
Renal function declines
When using the cockcroft-gault equation for estimating creatinine clearance and kidney function, what are 3 important factors to consider
-Reno function must be stable for formula to work
-if actual body weight (ABW) is less than ideal body weight (IBW), use ABW
-CAUTION using in elderly when serum creatinine is low due to decreased muscle mass — (can overestimate the clearance)
When pharmokinetic changes do not explain alterations in elderly, what is assumed to be the issue?
Pharmacodynamic changes
Which are more variable — pharmacokinetic or pharmacodynamic changes associated with age?
Pharmacodynamic
Name 5 important factors to consider when prescribing for older adults
-evidence based (what research has been done in elderly)
-risk-benefit of treatment vs watchful waiting vs non pharmacological
-they might not be able to administer the meds or be adherent
-socioeconomic barriers/affordability and access
-impact of DTC advertising
