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PHM 704: gremlins and wizards > Witches and Wizards: PKPD > Flashcards

Witches and Wizards: PKPD Flashcards

1
Q

breakdown of ‘geriatric’ ages

A
  • young old: 65-74
  • middle old 75-84
  • old old 85+
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2
Q

compared to younger pts, older pts are ____er, ____er, and ____er

A

fatter, dryer, weaker

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3
Q

cardiac changes

A
  • decrease in contraction and filling capacity -> less cardiac output
  • change in conduction -> arrhythmias
  • decreased efficiency
  • decreased catecholamines
  • athersclerosis -> stiffness
  • failure i venous valves -> increased risk in vte

collective cardiac changes increase dx of htn, tia, cva

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4
Q

CNS changes

A
  • decreased rate in conductoni
  • decresed strength in transmission
  • threshold for arousal blurred (some things more sensitive and others less sensitive); chages in electrical charge/signal needed for transmission
  • increased recovery time in ANS
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5
Q

respiratory changes

A
  • pretty normal at rest
  • compromized under stress (dyspnea on exertion)
  • decreased expiration
  • decreased elastiicity
  • decreased muscle
  • decreased ventilation
  • decreased O2
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6
Q

genitourinary changes

A
  • nephron degeneratio (loss in functional nephrons)
  • reduced glomerular and tubular function
  • decreased abilty to concentrate urine
  • decreased renal blood flow (independent of decreased cardiac output)
  • decreased acid base adaptation when stressed
  • incontinence
  • bph
  • ed
  • dyspareunia
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7
Q

situations/cases that can exacerbate the normal physiologic decrease in kidney function

A
  • inadquate fluid intake
  • fluid loss from diarrhea/vomiting
  • cardiac failure
  • sepsis
  • bad diuretic use
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8
Q

effect of normal physiologic decrease in kdiney functiton on drugs

A

reduced clearance of renally eliminated drugs -> supratherapeutic drug levles at normal doses

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9
Q

decrease in testoserone effets

A
  • decreased libido and sexual funciton
  • decreased energy
  • decreased muscle
  • decreased hair
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10
Q

gastrointestinal changes

A
  • dentition and nutrition -> malnutrition
  • decreased esophageal motility
  • hiatal hernia: (stomach pushes up through lower esophageal sphincter -> pain -> less eating
  • stomach is less acidic
  • decreased stomach motility
  • decreased colon motility
  • decreased pancreatic secretions
  • smaller liver
  • decreased blood flow to liver
  • decreased cyp450 in liver
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11
Q

(increased/decreased/same) stomach emptyig with age and consequential effect

A

decreased -> large insolule produts (asa 325 ec) stay in stomach longer -> decreased rate of absorption

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12
Q

(increased/decreased/same) rate of absorption in stomach with age and consequential effect

A

decreased -> decreased rate of absorptin of analgesics and hypotics (bad because we want pain meds to work fast)

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13
Q

(increased/decreased/same) intstinal motility with age and consequential effect

A

EITHER increased or decreased (trick question
- increased motility:
- increased absorptin dt increased dissolution
- decresed absorption (digoxin and phenytoin); less time to be absorbed
- decreased motolity: increased transit time -> increased absopriton of ldopa

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14
Q

(increased/decreased/same) gastric blood flow with age and consequential effect

A

decreased -> lower absorption of high permeability (water soluble) drugs

HF can also lower gastric blood flow

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15
Q

(increased/decreased/same) first pass effect with age and consequential effect

A

decreased -> increases F of drugs with high extration (high first pass clearance) -> start iwth lwoer dose
- propranolol
- morphine
- lidocaine
- verapamil
- labetolol

-> decreased F of active metabolite of prodrugs

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16
Q

effect of age on transdermal absorption

A

dry fat skin with low perufsio -> decreased absorptoin and rate of absorption of hydrophilic compounds (like fentanyl which is bad because we want pain meds to wrk fast)

skin gets even dryer and stuff in cachexia -> fentyl patch super not effectve

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17
Q

(increased/decreased/same) fat with age and consequential effect

A

increased fat -> increased Vd of lipophilic drugs (benzos)

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18
Q

(increased/decreased/same) water with age and consequential effect

A

decreased -> low Vd for hydrophilic drugs (Li, theophyline, aminoglycosides, EtOH)

drugmore [in blood]

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19
Q

(increased/decreased/same) muscle mass with age and consequential effect

A

decreased -> less distribution into muscle -> increased serum level (digoxin)

20
Q

(increased/decreased/same) albumin with age and consequential effect

A

same
- however albumin decreases in certain disease states (like frailty) -> incresed free fraction of acidic drugs (asa, phenytin ,vpa) -> increased effect of those drugs

21
Q

(increased/decreased/same) AAG with age and consequential effect

A

same no change lol
- however AAG may be elevated in certain conditions (acute illness, cancer, infection, inflammation) -> decreased unbound drug -> decrease effect

22
Q

there is a (increased/decreased/same) incidence of slow metabolziers in elderly compared to general population

A

same, but those slow metabolizers are realllll slow -> more susceptible to ADR

23
Q

drugs that the elderly may not metabolize well

A
  • benzos
  • nsaids
  • ccbs
  • psych meds (VPA, trazodone, haloperidol)
  • SSRI: sertraline, paroxetine)
  • fentanyl
  • warfarin
  • phenytoin
24
Q

drugs that have a significant renal component to elimination

A
  • hydrophilic beta blockers (atenolol
  • some ACEi
  • gabapenti
  • ABX: AGs, vanco, cipro,
  • heart: clonidine, digoxin
  • H2RAs
  • Li
  • metforomin
  • nicotinc acid
  • ripseridone

relavent for old people because their kidneys suck; think about drugs that we dose adjust based on kidneys

25
Q

(increased/decreased/same) CYP3A4 hepatic activity with age and consequential effect

A

decreased

26
Q

(increased/decreased/same) hydroxylation with age and affected drugs

A

decreased; affected drugs
- alprazolam
- triazolam
- midazolam
- quinidine
- propranolol
- R-warfarin

27
Q

(increased/decreased/same) demethylation with age and affected drugs

A

decreased; affected drugs
- imipramine
- sertraline
- verapamil
- theophylline

28
Q

(increased/decreased/same) glucoronidation with age and affected drugs

A

same; affected drugs
- lorazepam, oxazepam, temazepam

If VERY old >80 ; reduced a little (oxazepam)

29
Q

(increased/decreased/same) acetylation with age and consequential effect

A

same; affects isoniazid

30
Q

(increased/decreased/same) liver mass with age and consequential effect

A

decreased -> reducd hepatic metabolism

31
Q

(increased/decreased/same) liver volume with age and consequential effect

A

decreased -> redued hepatic metabolism

32
Q

(increased/decreased/same) liver blood flow with age and consequential effect

A

decreased (potentially ipacted by cardiac ouput) -> affects high extractio drugs

33
Q

clearance of asa and metoclopramide in frail patients

A

reduced

34
Q

(increased/decreased/same) GI active transport with age and consequential effect

A

decreased -> reduced F for some drgus

35
Q

if reduced clearance (increased/decreased/same) t1/2

A

increased t 1/2

36
Q

PD changes in elderly: change in baseline

A

at same [ ], an older person will experience more drug effect → lower [ ] achieve same effect, but adverse even threshold is also at lwoer [ ]

Same slope, higher x intercept

37
Q

PD changes in elderly: change in sensitivity

A

greater change in drug effect in older people per unit increase in drug [ ]

Same x intercept, steeper slope

38
Q

there is more research and literature in the eldrly on PK or PD

A

PK

39
Q

(increased/decreased/same) response to agonists and antags at beta adrenergic receptors 1 and 2with age and consequential effect

A

reduced ->
- diminshed reponse for isproterenol and propranlol
- hydralazine induced reflex cardiostimulation blunted
- hypotension
- beta adreneric response to hypoglycemia blunted

40
Q

(increased/decreased/same) cardiovagal tone with age and consequential effect

A

decreased -> vagolyti effects of atropine diminished

unclear but could affect vagolytic effects of TCA and antipsych

41
Q

CNS PD changes

A
  • altered neurotransmitters and/or receptors
  • hormonal changes
  • impaired glucose metabolism or decreased availability of glucose and oxygen as cerebrovascular function declines
  • extrapyramidal reactions
    • parknsonism reaction dominates dt already compromised nigrostriatial pathway
    • tardive dyskinesia
  • muscarinic deficit
    • role of anticholinergics in cog decline
42
Q

(increased/decreased/same) functional pgp activity in brain and consequential effect

A

decreased -> increased CNS drug [ ] and increased time in CNS

43
Q

(increased/decreased/same) benzo cns depression and consequential effect

A

increased -> lower blood [ ] needed for desired effects

44
Q

warfarin pd changes

A

decreased clearance and increased intrinsic sensitivity -> decreased dose needed

45
Q

uncharacteristic behaviors of drugs (both exagerated and blunted) are ofen due to (PD/PK) changes

A

PD

PHM 704: gremlins and wizards (16 decks)

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