Prescribing for the Elderly

Question 1

How is drug absorption affected by increased age?

Answer 1

gastric pH higher in elderly
increased GI transit time w/ aging
reduced intestinal absorptive area in elderly
HOWEVER, very little change in drug absorption overall. b/c oral drugs not absorbed in the stomach

Question 2

What is the best route for meds in the elderly?

Answer 2

liquid>films>tablets>capsules

Question 3

If you have a condition w/ low protein, specifically albumin in your body, what could that do to drug absorption?

Answer 3

low albumin makes it hard to deliver drugs throughout the body, warfarin, sulphonylureas

Question 4

What does acid 1 alpha glycoprotein do to drug absorption?

Answer 4

acid 1 alpha glycoprotein presents in acute illness & affects binding of basic drugs
lidocaine
propranolol
imipramine
disopyramide

Question 5

What happens to % water & fat in elderly?

Answer 5

water goes down

fat goes up

Question 6

Water soluble drugs that have decreased Vd in elderly?

Answer 6

atenolol
HCTZ
sotalol
theophylline
triazolam
aminoglycosides

Question 7

Fat soluble drugs that have increased Vd in elderly?

Answer 7

amiodarone
diazepam
haloperidol
increased Vd b/c more fat

Question 8

Which liver metabolism phase is more affected by aging?

Answer 8

PHASE 1: oxidation, reduction, hydrolysis
MOST affected by aging!
conjugation of Phase 2 is less affected by aging

Question 9

What happens to the half lives of amitriptyline
diltiazem
diazepam
warfarin in the elderly?

Answer 9

All increase!
diazepam much longer t1/2
amitriptyline much longer t1/2

Question 10

Which drugs do not have increased t1/2 for glucuronidation in the liver?

Answer 10

oxazepam
temazepam
glucuronidation is unaffected with these drugs

Question 11

Is excretion of drugs more difficult w/ age?

Answer 11

yes, b/c renally excreted & renal function decreases with age.

Question 12

Drugs predominantly eliminated via renal route?

Answer 12

digoxin
aminoglycoside antibiotics
lithium
spironolactone
vancomycin
**look at creatinine clearance 
**could be difficult to excrete in older patient

Question 13

Increased receptor sensitivity in elderly?

Answer 13

opioids

benzos

Question 14

Reduced response?

Answer 14

to beta adrenergic receptors

reduced to isoproterenol

Question 15

T/F Adverse drug reactions increase with age.

Answer 15

True.

Question 16

Warfarin is essentially a Vit ___ antagonist & decreases it w/ certain antibiotics.

Answer 16

Vit K

Question 17

What wouldn’t you want to take viagra with?

Answer 17

nitrates

could cause hypotension

Question 18

Which drugs should be avoided as much as possible in the elderly?

Answer 18

anticholinergics
long acting benzos (diazepam)
theophylline
NSAIDs-indomethacin causes severe GI disturbance at times
some opiates
antipsychotics