Geriatrics Flashcards
_____ is affected by the increase in body fat, decrease in lean body mass, and decrease in total body water.
Distribution
____ is least affected by the aging process, though it may be slowed.
Absorption
With age, liver makes less _____, so there is less protein binding.
Albumin
Do the elderly relatively have more or less fat? What does this have to do with drugs?
More fat
Plasma levels of lipid-soluble drugs might decrease in the elderly
Do the elderly relatively have more or less albumin? What does this have to do with drugs?
Less albumin
Free levels of drugs that have a high binding affinity to albumin may increase
Do elderly have more or less lean body mass and total water? What does this have to do with drugs?
Less - plasma concentrations of drugs that distribute in body water or lean body mass may increase
Phase I (oxidation) metabolism is ______(increased or decreased) in the elderly. What about Phase II (glucoronidation)?
Decreased
Phase II is relatively preserved
What will happen to drugs with high liver extraction ratios in the elderly?
Since elderly have less liver metabolism, plasma levels of these drugs will increase
What changes in renal elimination occur in elderly?
Relatively little change, though there is a gradual decrease in GFR with age.
What changes in receptors occur in elderly?
Most receptors decrease in # and signaling efficiency with age
What are risk factors for ADE’s?
- 6 or more concurrent chronic conditions
- 12 or more doses of drugs / day
- 9 or more medications
- Prior adverse drug reaction
- Low body weight or body mass index
- Age 85 or older
- Estimated CrCl < 50 mL / min
What are the common adverse effects of drug-drug interactions?
- Confusion
- Cognitive impairment
- Arterial hypotension
- Acute renal failure
- Edema/worsening CHF
- Altered GI function
- Gait and movement abnormalities
What are the principles of prescribing for older patients?
- Start with a low dose
- Titrate upward slowly, as tolerated by the patient
- Avoid starting 2 drugs at the same time
- Be aware of timing of medication to minimize side effects
What calculation do you need to make with geriatric patients?
Creatinine clearance
What is the ADE prescribing cascade?
Prescribing someone a new drug because adverse drug effects from a drug they’re currently on look like a new condition
