7. Medicine

Question 1

The body percentage of extracellular water (increases/decreases) with aging… intracellular water?

Answer 1

stays same… decreases

Question 2

Age alters what two aspects of drug effects

Answer 2

• Pharmacokinetics

- Pharmacodynamics

Question 3

Define pharmacodynamics and pharmacokinetics

Answer 3

Pharacokinetics
-How the body processes the drug after administration (how the body affects the drug)

Pharmacodynamics

• How the body reacts to the drug at receptor sites
• How drug affects the body

Question 4

What are the five elements of pharmacokinetics

Answer 4

L= liberation 
A= Absorption 
D= Distribution 
M=MEtabolism 
E=Excretion

Question 5

What factors influence pharmacodynamics

Answer 5

• Receptor status
• Genetic factors
• Drug interactions
• Drug tolerance

Question 6

Factors that influence absorption are

Answer 6

• Alterations in GI function
  
  • Reduced motility
  • Increased pH
  • reduced first-pass effect
• Use of concomitant meds
  
  • pH changes
  • reducing absorption

Question 7

Aspect of PK least affected by aging

Answer 7

Absorption

Question 8

Describe distribution

Answer 8

Where the drug goes after it enters the blood

Question 9

Factors that influence distribution

Answer 9

• Reductions in protein binding
• Increased % body fat
• Decreased muscle
• Decreased total body water

Question 10

Two main organs of drug metabolism are

Answer 10

liver

kidney

Question 11

First pass metabolism (increases/decreases) with age

Answer 11

decreases due to reduced liver function

Question 12

How can you measure kidney function

Answer 12

GFR

-Creatinine clearance (Cockcroft-Gault equation)

Question 13

Factors that influence PD

Answer 13

• Distribution to biopahse (site of action reached?)
• Receptor affinity
• Receptor number
• Post-receptor events
• Homeostatic control mechanisms
• NO generalizations

Question 14

Examples of antiplatelet agents

Answer 14

• Clopidogrel (plavix)
• Aspirin
• Ticagrelor
• Prasugrel

Question 15

Examples of anticoagulant drugs

Answer 15

• Warfarin
• Pradaxa
• Eliquis
• Xarelto

Question 16

Patients most likely on anti-coagulants are

Answer 16

atrial fibrilation

Question 17

Other brugs of caution for bleeding

Answer 17

• NSAIDs
• SSRI/SNRI
• Omega 3 fatty acid
• Herbals (garlic, cordyceps, saw palmetto)

Question 18

Effect of NSAIDs on bleeding

Answer 18

reversible inhibition of platelet aggregation

Question 19

Effect of SSRI/SNRI on bleeding

Answer 19

may impair platelet agg.

Question 20

Effect of Omega 3 FA on bleeding

Answer 20

Prolong bleeding time (potentially

Question 21

What drug results in irreversible inhibition of platelet agg.

Answer 21

aspirin

Question 22

Aging results in changes to

• CNS clearance
• BBB permeability

Answer 22

decrease…increase

Question 23

Commonly used classes of drugs for sedation are

Answer 23

• Induction agents
• Muscle relaxants
• Anesthetic gases

Question 24

Considerations for sedation are

Answer 24

• Postop delirium (POD)

- POstop cognitive dysfunction (POCD)

Question 25

POD and POCD lasts how long

Answer 25

``` POD= 24-72 hrs POCD= weeks to months ```

Question 26

How to reduce risks of sedation

Answer 26

- Choice of sedative (short duration action) - Slow titration - Shortest duration possible

Question 27

Rule of thumb for sedation

Answer 27

reduce intiial dose by 50% in geriatic patients over 70 yrs old

Question 28

Strategies for healthy perscribing

Answer 28

- Treat indications not symptoms - Weigh risks and benefits - Know patients health history and meds they are taking - Simplify regimen avoid PRN and monotherapy - Educate patients about effects both therapeutic and toxic - Consider new symptoms may be drug induced

Question 29

Sympathetic nervous system stimulates (thick/thin) saliva production. Patients on anti-cholinergic meds will have (thick/thin) saliva

Answer 29

Sympathetic= thick PSNS= thin | -Anti-cholinergics --> thick saliva

Question 30

Common xerogenic drug classes

Answer 30

- Anti-histamines - Anti-hypertensives(alpha agonists and blockers and beta blockers) - Anti-psychotics - Bronchodilators (anti-muscarinics, and beta agonists) - Decongestants - Opioid

Question 31

Which will have worse xerostomia (1st/2nd) gen antihistmaines and why

Answer 31

1st becasue they penetrate the BBB

Question 32

Pilocarpine and cevimeline are what kinds of drugs

Answer 32

cholinergic agonist (muscarinic agonist)

Question 33

Uses for pilocarpine and cevimeline are

Answer 33

- Uncontrolled asthma - Glaucoma - Iritis

Question 34

Caution should be taken when using pilocarpine and cevimeline in what patients

Answer 34

- Active cardiac disease - Biliary tract disease - hepatic disease

Question 35

Side effects of pilocarpine and cevimeline

Answer 35

- Sweating - Flushing - Dizziness - Rhinitis - Increased urinary freq

Question 36

Use of amifostine is

Answer 36

xerostomia prophylaxis (acute and chronic)

Question 37

Does amifostine negativelt affect cancer treatment

Answer 37

no

Question 38

Indications for amiforstine

Answer 38

- Patients undergoing radiation (xerostomia prophy) for head/neck cancer - Radiation includes substantial portion of the parotid glands

Question 39

Amifostine is administered how

Answer 39

IV

Question 40

Adverse effects of Amifostine

Answer 40

hypotension | neusea and vomitting