Week 2: Geriatric Pharmacology

Question 1

What is the management of the drug by the body (absorption, distribution, metabolism, excretion)?

Answer 1

Pharmacokinetics

Question 2

As patients age, the stomach has a _____ pH.

Answer 2

increased

Question 3

What drugs are affected by changes in absorption?

Answer 3

Ketoconazole, iron supplements

Question 4

What are the changes that occur with absorption as one ages?

Answer 4

decreased surface area and blood flow to GI, decreased GI motility, increased pH

Question 5

What are the changes that occur with distribution as one ages?

Answer 5

protein binding (decreased albumin, increase a1 acid glycoproteins and lipoproteins), volume of distribution (less total body water, higher fat content, lower lean muscle mass)

Question 6

What is important about decreased albumin?

Answer 6

binds acidic drugs, malnourished elderly, need a lower dose of acidic protein bound drugs

Question 7

What is important about increased a1- acid glycoprotein and lipoproteins?

Answer 7

increases inflammation, stress, injury and binds basic drugs so need higher doses of basic protein bound drugs

Question 8

What drugs are affected by (decreased) albumin?

Answer 8

digoxin, theophylline, phenytoin, warfarin, diazepam

Question 9

What drugs are affected by (increased) A1-acid glycoprotein/lipoproteins?

Answer 9

propanolol, quinidine, lidocaine

Question 10

What is important about less total body water?

Answer 10

need a lower dose of hydrophilic drugs

Question 11

What is important about higher fat content?

Answer 11

need a lower dose of lipophilic drugs

Question 12

What is important about lower lean muscle mass?

Answer 12

digozin binds to muscle, so concentration increases as a result in increased Vd (digoxin toxicity at lower doses than expected)

Question 13

Which drugs are hydrophilic?

Answer 13

lithium, aminoglycosides, ethanol

Question 14

Which drugs are lipophilic?

Answer 14

phenothiazines, phenytoin, diazepam, barbiturates, propanolol

Question 15

What are the changes that occur with metabolism as one ages?

Answer 15

reduced hepatic blood flow, reduced hepatic mass and number of functioning hepatocytes

Question 16

The _____ is the primary site for metabolism of most medications.

Answer 16

liver… so some drugs rate of metabolism is dependent upon rate of hepatic blood flow

Question 17

What is important about reduced hepatic flow?

Answer 17

decreased flow leads to reduced amount of drug extracted by the liver for metabolism during first pass, leading to increased bioavailability of the drug

Question 18

What drugs are affected by reduced hepatic blood flow?

Answer 18

calcium channel blockers, beta blockers, narcotics, nitrates, tricyclic antidepressants, hydralazine, labetalol

Question 19

What is important about reduced hepatic mass and number of functioning hepatocytes?

Answer 19

decline in Phase I and II metabolism

Question 20

What drugs are affected by reduced hepatic mass and number of functioning hepatocytes?

Answer 20

diazepam, alprazolam, chlordiazepoxide, amitryptyline

Question 21

What are changes that occur with excretion/elimination as one ages?

Answer 21

renal function decreases with are, creatinine clearance decreases,

Question 22

What is a better indicator of renal function?

Answer 22

creatinine clearance

Question 23

What is important about reduced renal function?

Answer 23

drugs and drug metabolite often remain active for longer periods, thus prolonging drug effects and increasing risk for toxic side effects… drug half life is often substantially longer

Question 24

What is polypharmacy?

Answer 24

use of 4 or more medications by a patient.

Question 25

What is the prescribing cascade?

Answer 25

medications prescribed to treat side effects of other medications

Question 26

What is an adverse drug reaction?

Answer 26

any unwanted and potentially harmful effect caused by a drug when the drug is given at the recommended dosage
an injury caused by taking a medication
may occur following a single dose or a prolonged administration or result from combination or two or more drugs

Question 27

What is an adverse drug event?

Answer 27

any injury occurring at the time a drug is used, whether or not it is a identified as the cuase

Question 28

What is orthostatic hypotension?

Answer 28

20 mmHG systolic decrease or 10 mmHG diastolic decrease

Question 29

What can PT procedures have a negative interaction on with some medications?

Answer 29

Procedures that cause extensive peripheral vasodilation may produce severe hypotension in the patient receiving certain drugs with the same type of effect.