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DEN303 - IHD > Geriatric Pharmacology > Flashcards

Geriatric Pharmacology Flashcards

Describe the effect and implications of ageing and co-morbidity on pharmacokinetics and pharmacodynamics Identify key issues in geriatric co-morbidity Explain common adverse drug reactions in the elderly and identify the most common drug-drug and drug-disease interactions

1
Q

Absorption - alteration with age

A

Rate of absorption may be delayed
Lower peak concentration
Delayed time to peak concentration being reached

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2
Q

Factors affecting absorption

A 
Route of administration 
What is taken with drug - food/drugs affecting GI motility and pH 
Co-morbidity 
Decreased gastric emptying 
Dysphagia
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3
Q

Elderly have

Reduced

Increased

A

Lean body mass
Water
Serum albumin
Kidney weight

Fat as a percentage of body mass

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4
Q

Effect of reduced lean body mass

A

Reduced VD for drugs which bind to muscle

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5
Q

Effect of reduced body water

A

Reduced VD for hydrophilic drugs e.g lithium

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6
Q

Effect of reduced plasma protein

A

albumin

increased % of unbound or free drug e.g diazepam

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7
Q

Effect of increased fat store

A

Increased VD for lipophilic drugs e.g diazepam

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8
Q

Effect of increased plasma protein

A

α1-acid glycoprotein

Reduced % unbound drug

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9
Q

Volume of distribution

A

VD

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10
Q

Effect on metabolism via liver

Causes of change in metabolism

When do most changes occur?

A

Does not appear to decline equally for all drugs

Decreased blood flow to liver
Decreased liver mass
Decreased ability to heal from injury/malnutrition
Diseases affecting hepatic fx e.g heart failure

Phase 1 reactions involving P450

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11
Q

Stages of metabolism

A

Phase 1 - modification
- oxidation, reduction, hydrolysis

Phase 2 - conjugation

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12
Q

Phase 1 metabolic stage - and in the elderly?

Phase 2 metabolic stage

A

Oxidation, reduction and hydrolysis - changes STRUCTURE of molecule
Converts drugs into metabolites to help excretion
Hepatic clearance of drugs metabolised by this is more likely to be prolonged

Adds charged species
Medications are generally preferred in elderly as no accumulation of active metabolites

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13
Q

Elimination of drugs - in elderly?

What happens if it doesn’t occur

Muscle mass loss

A

Kidney usually - function depleted with age

Prolongation of drugs and potential for accumulation to toxic level
Results in serum creatinine increase - clearance decreased in 2/3

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14
Q

Causes of reduced elimination

Effects

A

Decreased kidney size
Decreased renal blood flow
Decreased number of functional nephrons
Decreased tubular secretion

Decreased GFR
Decreased drug clearance

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15
Q

Factors affecting drug metabolism

A

Cardiac index
Maximal breathing capacity
Glomerular filtration

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16
Q

Effects of ageing on pharmacodynamics for

Benzodiazepine

Analgesics

Beta blockers

Anti-cholinergic agents

A

Increased sensitivity to sedation and psychomotor impairment

Increased level and duration of pain relief

Reduced heart rate response

Increased sensitivity

17
Q

Factors contributing to adverse drug reaction

A

Altered organ fx
Decreased homeostatic regulation
Altered drug conc
Multiple drug administration

18
Q

ADEs
How many are preventable?
When do most errors occur?

Risk factors? 3x

A

Adverse drug effects

50%

Ordering and monitoring

Polypharmacy
Co-morbidity
Low body weight/BMI

19
Q

Drug drug interactions

Risk increases with?

Causes

Which drugs are they most common with

Adverse effects ?

e.g benzodiazepine + antidepressant

A

Number of medications taken

Increased/decreased absorption 
Additive effects
Antagonising effects
Changes in metabolism 
Duplication of drug therapy

CV and psychotropic

Confusing, acute renal failure, cognitive impairment, hypotension

sedation+confusion

20
Q

Drug-disease interactions

Causes
Obesity 
Ascites 
dementia 
Renal/hepatic dysfunction

NSAIDs + hypertension

A

Alters VD of lipophilic drugs

Alters VD of hydrophilic drugs

Increases sensitivity to CNS or anticholinergic drugs

Impairs metabolism+excretions of drugs

Fluid retention, decreased effect of diuretics

21
Q

Principles of prescribing for elderly

A 
Start low dose and increase slowly 
Avoid mixing agents 
Use one medication for two conditions 
Consider interactions 
Adjust doses for renal and hepatic status 
Avoid prescribing for side effects
22
Q

Common errors in prescribing for elderly people

A

Polypharmacy

Missing side effects

23
Q

Compliance problems

A

Opening containers
Cognitive impairments
Fear of choking whilst swallowing
Depression

DEN303 - IHD (58 decks)

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