Prescribing in the Elderly

Question 1

name the 4 components of pharmacokinetics

Answer 1

ADME
absorption
distribution
metabolism
excretion

Question 2

what does DOAC mean?

Answer 2

direct acting oral anticoagulant

Question 3

acidic drugs require a/an ___ pH for absorption

Answer 3

acidic

Question 4

morphine is an acidic drug T or F

Answer 4

F, basic

Question 5

older people have a more acidic/basic environment

Answer 5

basic

Question 6

how does an increased gastric pH affect small bowel surface area?

Answer 6

decreases it

Question 7

what is the best preparation for older people who are taking drugs orally?

Answer 7

liquids/syrup

Question 8

what kind of binding do drugs need to undergo before they begin to act?

Answer 8

protein binding

Question 9

what kind of protein binds to acidic drugs

Answer 9

albumin

Question 10

is albumin acidic or basic

Answer 10

basic

Question 11

what kind of protein binds to basic drugs?

Answer 11

alpha 1 glycoprotein

Question 12

is alpha 1 glycoprotein acidic or basic?

Answer 12

acidic

Question 13

increased fat in old people increases the __ of fat soluble (lipophylic) drugs

Answer 13

volume of distribution (Vd)

Question 14

what is Vd?

Answer 14

the volume if all the drug you gave to the patient was distributed in the plasma

Question 15

a high Vd means alot of the drug has distributed itself into ___ instead of ___

Answer 15

fatty tissue instead of plasma

Question 16

a low Vd means alot of the drug has distributed itself into the ___ instead of ___

Answer 16

plasma instead of fatty tissue

Question 17

a high Vd means the drug is lipophylic T or F

Answer 17

T

Question 18

a low Vd means the drug is hydrophilic T or F

Answer 18

T

Question 19

define half life

Answer 19

the time it takes for a drug to go down to half its level of activity

Question 20

how to work out half life of a drug

Answer 20

Vd/Cl

Question 21

a lipophylic drug is going to have a __ half life

Answer 21

long (Vd is higher)

Question 22

why is clearance lower in old people?

Answer 22

liver and kidneys dont work as well

Question 23

older patients have __ half lifes, why is this?

Answer 23

longer

drug hangs about in their system for longer as liver and kidneys dont work as well

Question 24

albumin is __ in old people

Answer 24

low

Question 25

older patients have more first pass metabolism T or F, why is this

Answer 25

F, it is slower because liver function is reduced

Question 26

why is GFR lower in old people

Answer 26

tubular secretion rate reduced
renal blood flow reduced
larger size

Question 27

why is creatinine not helpful as a marker in old people?

Answer 27

is muscle dependent and old people dont have much

Question 28

why do B blockers have less effect in older people?

Answer 28

less B2 receptors

Question 29

define the therapeutic index

Answer 29

maximum toxic conc/ minimum effective conc

Question 30

what value would give a drug a narrow therapeutic index?

Answer 30

<2

Question 31

name an antibiotic with a narrow therapeutic index

Answer 31

gentamicin
vancomycin
cyclosporin

Question 32

the therapeutic window __ with age

Answer 32

decreases

Question 33

most common side effect of opioids

Answer 33

constipation

Question 34

what should be given to prevent constipation with opioids?

Answer 34

senna or lactulose

Question 35

what drug type is known to cause iatrogenic diabetes?

Answer 35

steroids

Question 36

long term NSAID treatment doesn’t work in patients with ____

Answer 36

hypertension (NSAIDs cancel out the effect of hypertensive agents and diuretics)

Question 37

what combination of pain drugs is particularly bad for falls

Answer 37

opioids and benzodiazepines

Question 38

what drugs are good at treating both hypertension and angina?

Answer 38

CCB

BB

Question 39

statins should only be given for up to _ months post MI

Answer 39

6