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SBM > SBM: Pharmacology & therapeutics - Elderly > Flashcards

SBM: Pharmacology & therapeutics - Elderly Flashcards

1
Q

What is Pharmacodynamics?

A

effect of drug on the body?

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2
Q

what is pharmacokinetics?

A

Way the body affects the drug/

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3
Q

What is involved in pharmacokinetics?

A

Absorption
Distribution
Metabolism
Excretion

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4
Q

Why does absorption reduce in the elderly?

A

reduced saliva, reduced gastric acid, reduced GI motility, reduced SA for absorption. REDUCED SPLANCHNIC blood flow

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5
Q

Describe what happens to absoption in the elder?

A

Decrease rate of absoption and increased time to steady state

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6
Q

Describe volume of distribution with an equation

A

Vd = [drug] in body /[plasma]

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7
Q

What is the Vd?

A

Hypothetical volume obtained if ALL the drug was in the blood

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8
Q

What is the importnace of Vd? (What does it affect)

A

Affect half lfie and duration of effect

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9
Q

What is the relationship between muscle in the elderly and Vd?

A

Elderly - Decreased muscle, therefore volume of drug that distribute into muscles reduces –> Vd decreases. Thus the plasma conc increases.
E.g. Digoxin

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10
Q

What is the relationship between Body Fat in the elderly and Vd?

A

Elderly - Increase fat, therefore volume of distribiton for fat soluble drugs increases. Vd INcreases. Thus the plasma conc decreases.
E.g. Benzodiazepine

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11
Q

What happens to the half life in drugs that are fat solube in the elderly?

A

Increases

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12
Q

What is the relationship between water in the elderly and Vd?

A

Elderly - Decreased water, therefore volume of distribiton for water soluble drugs decreases -> Vd decreases. Thus the plasma conc increases.
E.g. Digoxin

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13
Q

What is the consequence of lower Vd in water soluble drugs?

A

Lower loading doses

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14
Q

What is the consequence of getting old on albumin

A

decrease by 12-25%.

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15
Q

Lower albumin means what on drug vd?

A

Therefore drug binding reduces by 12-25%. This increases the amount of free drug

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16
Q

what is the process of metabolism?

A

Drug goes through phase 1. This is mostly inactivation of the drug. some are activated, some have no change. This leads to oxidation/reduction/hydrolysis products. This then goes onto Phase 2 - which INACTIVATES all drugs. leaving synthetic or conjuate products.

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17
Q

What happens to metabolism in the elderly?

A

decreased liver volume (30%), decreased liver blood flow (12-40%). This then decreases first pass metabolism due to decreased blood flow. The enzyme CYP450 is reduced.
this therefore reduces clearance of the drug.
increases half life. E.g. CCB

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18
Q

What happens to excretion in the elderly?

A

decreases renal blood flow, mass, fucntion (all by 20-30%). GFR declines by 1% every year after 40

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19
Q

What happens to the half life in drug with a reduced renal excretion?

A

Increased Half life

20
Q

Example of drug excreted by the kidney

A

Digoxin, atenolol, sotalol, Li

21
Q

What are the therapeutic implication ofreduced renal function?

A

Reduced doses in once daily preps. Increase dose intervals to give more time to excrete.

22
Q

What is the relevance of absorption in the elderly?

A

L-Dopa- competes with nutrients. Therefore plan dosing to avoid meal times.

23
Q

Describe Digoxin toxity?

A

cardiac - heart block, bradycardia, junctional tachycardia, Pschiatric - Delirium, fatigue, malaise, confusion.
Visual - blurred, double vision, yellow-green vision, photophobia
GI - nausea vomiting, anoxeria, diarrhoea, abdo pain

24
Q

Describe increase benzo in the blood stream

A

drowsiness, confusion, ataxia, dependance.

25
Q

How do you treat digoxin toxicity

A

electrolyte fluid

digibind = digoxin specific antibody binding

26
Q

how do you treat benzo toxity?

A

IV Flumazenil

Antagonist

27
Q

what are the symtpoms of phenytoin toxicity?

A

nausea, vomitting, tremor, Ataxi, nystagmus, coarse facies, hepatitis.

28
Q

Describe warfarin = aspirn interaction

A

Warfarin is bound to albumin 99%. Aspirin can displace the warfarin from albumin. due to increase of free warfarin –> toxic as warfarin has low therapeutic index. icnrease in bleeding

29
Q

What type of drug is aspirin

A

antiplatelet

30
Q

what type of drug is warfarin

A

anti coagulant

31
Q

What are the early, intermediate, and late symptoms of Li toxicity?

A

Early - tremor, agitation, twitching
Intermediate - lethargy
Late - coma (haemodialysis may be needed)

32
Q

describe morhphine toxicity symptoms

A

nausea, vomiting, constipation HYPOTENSION, RESP DEPRESSION

33
Q

Treatment of morphine toxicitiy?

A

Naloxone iv 400mcg

34
Q

how do pharmacodynamics change in the elderly?

A

Decline. maybe due to: receptor affinity/number. alterations in second messenger function/alteration in cellular and nuclear respnses.

35
Q

Some drug effects are increased. As in some of the pharmacodynamics are INCREASED. Name some (4-7)

A

Alcohol, benzodiazepine (enhanced sedation), warfarin, hypotensives (postural hypotension) NSAIDs, Anticholinergics, Phenothiazine

36
Q

Some drug effects are decreased. As in some of the pharmacodynamics are DECREASED. Name some (3)

A

B1 modulator in cardiac tissue (down regualted by 1/3)
Reduced resposne to B Agonists
CCB on PR interval is decreased

37
Q

List the common side effects of antihypertensives.

A

Hypotension,

38
Q

What s/e occur in ACEi

A

Hypotension, K Sparing, renal failure, Cough

39
Q

What s/e occur in CCB

A

Hypotension, Fluid retention

40
Q

What s/e occur in B Blockers?

A

Hypotension, Confusion, bradycardia, Impotence

41
Q

What s/e occur in Diuretics/

A

Hypotension, hypokalaemia, hyponatremia, confusion, dehydration.

42
Q

What s/e occur in Major antipsychotics?

A

Confusion, sedation, EPS?, Parkinsonism, Tardive dyskinesia

43
Q

What are adverse effects of steroids?

A

Osteoporosis, gastric irritation/ulcers/hypergylcaemia

44
Q

What are adverse effects of Tricyclic antidepressants?

A

cardiac arrhythmias, drowsiness, dry mouth, Constipation, urinary retention, cogntiive impairment (anti-cholingergic - stimulates sympathetic system)

45
Q

What are adverse effects of NSAIDs?

A

Gastric irritation, renal failure, fluid retention

SBM (13 decks)

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