Week 3 Flashcards by AIyssa Agustin

How may the absorption of medications change for pts >65?

increased gastric pH
decreased gastric emptying
” Ca++ absorp
” first pass effect
- increased bioavailability for beta blockers/opiates because fraction of meds aren’t loss as much as younger individuals
inhibition of cytochrome P450 pathway
- increased bioavailability of some drugs(might get too much of drug cos they metabolize slower)

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How can metabolism of meds changed for >65 yos?

decreased blood flow to hepatic circulation
decreases metabolism of the drug
- >half life, especially cardiac drugs

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How can distribution of meds change for pts over 65?

fluctuations in body water volume
increase in body fat distribution
- lipophilic meds include opiates

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How can excretion of meds change for pts >65?

decrease
- creatinine clearance
- glomerular filtration rate
drug clearance reductions
- amantadine (antiviral for flu)
- aminoglycosides (gentamycin)
- atenolol, captopril
- cimetidine - tagamet
- digoxin
- lithium
- vancomycin
reduced renal mass = reduced nephron #
- renal blood flow down TF GFR down

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What medications are underused?

ACEI’s
beta blockers
anticoagulants
bisphosphonates

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What medications are inappropriate to use in Nursing homes?

nitrofurantoin
amiodarone
disopyramide
nifedipine
ticlopidine
cimetadine
metoclopramide
chlorpheniramine (anti-histamine)
NSAID’s
Fentanyl
Methadone
glyburide
promethazine

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What is the drug-disease interactions for anti-hypertensives?

syncope

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What is the drug-disease interactions for anti-cholinergic?

BPH
constipation
dementia

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What is the drug-disease interactions for ASA?

Peptic ulcer disease

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What is the drug-disease interactions for benzodiazepines?

dementia
falls

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What is the drug-disease interactions for bupropion?

siezures

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What is the drug-disease interactions for calcium channel blockers?

heart failure

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What is the drug-disease interactions for steriods?

diabetes

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What is the drug-disease interactions for opiates?

constipation

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What are the side effects of Aricept (donepezil)?

nausea
diarrhea
insomnia
falls
increased infection

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What is Aricept (donepezil) used for and how can it negatively impact pts?

dementia
interacts neg w/ anticholinergics, antidepressants, and some antibiotics

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What effect does digoxin have on elderly?

antiarrhythmic
- risk of toxicity
- reduced drug clearance

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What affect does amiodarone have on elderly?

antiarrhythmic
- HR drop
- AVOID

Disopyramide effect on elderly?

induce heart failure
AVOID

Nifedipine effect on elderly?

risk for hypotension
AVOID

What class are Calcium Channel blockers?

anti-hypertensives
- can cause heart failure

What effects can the anti-hypertensive Calcium Channel Blockers have on the elderly?

syncope (fainting), dizziness
decreases vasodilator therapy
HIGH RISK

What is the diuretic furosemide (Lasix) effect on elderly?

neurological issues
dizziness
hypotension
HIGH RISK

What are some anticoagulants that effect elderly?

Pradaxa
Xorelto
Warfarin (HIGH RISK)

What does anticoagulants do to elderly?

* increased sensitivity * caution w/ pts \>75 * risk for serious bleeding

What are examples of anti-cholinergic meds?

* Ditropan, Detrol * overactive bladder * Atrovent (COPD) * Spiriva, robinal, benadryl, dramamine, * chlorpheniramine (anti-histamine), promethazine * AVOID

What do anticholinergic drugs do to elderly?

* increased cognitive impairment * BPH * constipation * dementia * EXCEPT LORATADINE (usually prescribed w/ aricept)

What are some common anti-depressants?

* tricyclics-amitriptyline(AVOID) * Paxil-paroxetine (AVOID) * Celexa, Lexapro, Zoloft (OK)

How do anti-depressants affect elderly?

* disoriented * confusion * impaired thinking/rxn * SSRI BETTER CHOICE FOR ELDERLY

What are examples of NSAIDS that you should AVOID for elderly care?

* ASA * Ibuprofen

How do NSAID's affect elderly?

* peptic ulcers/bleeding * dont give w/ anti-coagulants

What affect do benzodiazepines have on elderly?

* usually end in -lam, -pam * increased sensitivity * dementia, falls (sedation)

What effect can corticosteroids (HIGH RISK) have on elderly?

it can increase blood sugar, possibly leading to diabetes

What class are methadone and fentanyl?

opiates

Effect of opiates on elderly?

* increased bioavailabilty and sensitivity * constipation

What class is Aricept?

cholinesterase inhibitors

What are examples of H2 blockers?

* Zantac * **Cimetadine (AVOID)** * Pepcid

What effect do H2 blockers have on elderly?

cause confusion but lower doses okay

What can you use thats better H2 blockers than Zantac, Cimetadine, and Pepcid?

PPI (Prevacid) or antiacid

What is an example of a methylxanthine?

Theophylline (HIGH RISK)

Why is it riskier to administer theophylline / methylxanthines to elderly?

risk of toxity due to reduced clearance of med

What does Metoclopramide do to elderly?

can cause neurologic disorder

What can glyburide do to elderly?

prolonged hypoglycemia