Principles in Geriatric and Pediatric Pharmacology

Question 1

In a patient with decreased clearance of a drug, the loading dose ____________ and the maintenance dose ________________.

Answer 1

stays the same; decreases

Question 2

The fluoroquinolones are excreted ____________.

Answer 2

renally (after being metabolized by the liver)

Question 3

The macrolides are metabolized _______________.

Answer 3

by the liver

Question 4

In general, the volume of distribution ___________ with age.

Answer 4

decreases for hydrophilic molecules (because the lipid portion of the body increases) and increases for hydrophobic molecules (same)

Question 5

Which enzyme converts acetaminophen to its toxic metabolite?

Answer 5

2E1

Question 6

Discuss how the ability to conjugate drugs changes from birth to adulthood.

Answer 6

• Birth: able to sulfate and glycine conjugate drugs at birth
• Acetylation and glucuronide conjugation develop by 2-3 years

Question 7

In general, ____________ clearance is less variable in children and is more rapid than in adults.

Answer 7

renal

In fact, some drugs needed to be given at increased doses in children because of renal clearance.

Question 8

Because of Reye syndrome, ____________ is not offered in liquid solution.

Answer 8

aspirin

Question 9

In a kid younger than 12, give _____________ for atypical pneumonia.

Answer 9

azithromycin

Question 10

Absorption is generally only different for those younger than _____________.

Answer 10

one year, especially during the first 30 days of life

The decreases in absorption in the elderly are not usually of clinical significance.

Question 11

Explain how the changes in body composition change the volume of distribution over age.

Answer 11

In general, the volume of distribution is not altered by changes in body composition; thus, loading dose should remain roughly the same.

Question 12

Why does chloramphenicol lead to gray baby syndrome?

Answer 12

It cannot be effectively cleared by the liver.

Question 13

Describe how pharmacokinetics changes with age.

Answer 13

In general, the effects of drugs at receptors changes very little and the serum concentration needed to have an effect does not change either.

Question 14

When is body area measured?

Answer 14

In general, only when the dose of a drug needs to be extremely controlled (such as with chemotherapy).

Question 15

Why is mixing liquid medicines into formula not recommended for babies?

Answer 15

Babies might not consume the entire bottle, so the dose will be incomplete.

Question 16

Corticosteroids can suppress ______________.

Answer 16

growth via inhibition of growth hormone release at the pituitary

Question 17

As we age, our stomachs tend to be ____________.

Answer 17

less acidic (this leads to increased absorption of basic drugs and decreased absorption of acidic drugs) and have less motility

Question 18

Phase _______ metabolism decreases with age.

Answer 18

I (phase II metabolism is usually unaffected)

Note: this is why oxazepam and lorazepam are preferred over chlordiazepoxide and diazepam –O and L are metabolized by phase II reactions!

Question 19

Some phase I metabolic enzymes are not at adult levels until _____________.

Answer 19

the teens

Question 20

If a drug has a higher volume of distribution in the elderly –like, for instance, diazepam –then you may need to adjust the ____________.

Answer 20

loading dose upward (because increased Ld is required for increased Vd)