Sept10 A2-Drugs and Aging Flashcards
things affecting pharmacokinetics in elderly
- changes in body composition
- discrepancy in energy prod and use (HR)
- homeostatic dysregulation
- neurodegeneration
- drop in GFR
- drop in cardiac index
- drop in maximal breathing capacity
some geriatric syndromes
- anorexia, malnutrition
- gait disorders, falls
- disability
- disease susceptibility, comorbidity
- urinary incontinence
- decubitus ulcers
- sleep disorders
- delirium
- cognitive impairment
top things seniors are being treated for
- high BP and heart failure
- high cholesterol
- GI
- depression
- diabetes
- respiratory
- osteoporosis
problems with how drugs work for elderly
not sure if can be given bc
- trials done on people with no comorbidities (whereas elderly would have CVD for ex)
- trials on younger people, on small pop of adults
top drugs given to elderly
- statins
- PPI
- ACEi
- beta lockers
- dihydropyridine CCB
- TH
- ARB
- natural opium alkaloids (pain)
- biguanides (diabetes)
- benzodiazepine derivatives (agitation, anxiety, insomnia, seizures)
key reason to understanding pharmacokinetics
determine the therapeutic window
therapeutic window changes how with age
gets narrower
how absorption of drugs changes with age
doesn’t change
how does ability of a drug to reach its target change with age
not a huge change. (BUT, changes in body comp still)
- less total body water
- less lean body mass
- more body fat
- less serum albumin
- water soluble drugs have less volume of distribution and greater conc
- fat soluble drugs have geater volum of distribution and less conc
how metabolism changes in elderly
- drop in phase 1 metabolism in liver (putting on a hydroxy group = conjugation. note phase 2 unchanged) so may accum the drug if don’t eliminate it
- drop in GFR
- increased half life of drugs
digoxin toxicity is related to what
reduced GFR leading to reduced digoxin clearance
pharmacokinetics global result in elderly, how it changes
drug conc might increase in the toxic range, compared to young people
how do pharmacodynamics change in elderly (does R function change: receptor density, signal transduction, etc.)
no evidence
polypharmacy def (in elderly)
taking a lot of drugs, elderly take more drugs
top 10 classes of drugs causing adverse drug reactions in the elderly
- aco (warfarin and antiplatelet drugs) = 25% of ADR hospitalizations
- antineoplastic
- opioids and analgesics
- glucocorticoids and synthetic analogues for asthma
- beta blockers
- NSAIDs (excluding salicylates)
- loop diuretics
- thiazides
- other diuretics
- ACEi
