Cases in Geriatric Pharmacology

Question 1

______________ is always the right anser on boards.

Answer 1

“Discontinue the amitriptyline”

Question 2

In general, the evidence supporting many therapies is conducted on __________.

Answer 2

younger people

Question 3

Which of these changes the least with age? 
•Absorption
• Distribution
•Metabolism
•Elimination

Answer 3

Absorption

Question 4

_____________ is less absorbed with a high protein diet.

Answer 4

Carbidopa/levodopa

Question 5

Why is propranolol used to treat essential tremor (as opposed to a different beta-adrenergic antagonist)?

Answer 5

Propranolol is one of the most lipophilic beta-antagonists and crosses the BBB.

Question 6

Many of the benzodiazepines have long half-lives due to _________________.

Answer 6

persistence of active metabolites

Question 7

Describe the differences in active metabolites by phase I and phase II reactions?

Answer 7

Phase II always converts to inactive form, while phase I may convert to more active form

Question 8

Which of these accounts for the greatest difference in pharmacokinetics with age? 
• Absorption
•Distribution
• Elimination 
•Metabolism

Answer 8

Elimination

Question 9

What is the Cockroft-Gault equation?

Answer 9

[ (Ideal weight in kg) x (140 - age) ]
__________________________ x 0.85 (if female)
(72 x serum creatinine)

This gives estimated GFR.

Question 10

Two important reasons for adverse drug reactions in the elderly are __________________.

Answer 10

noncompliance and polypharmacy

Question 11

Give an example of noncompliance leading to adverse drug reactions.

Answer 11

This lecturer gave an example of a patient who had four antihypertensive medications prescribed at maximum doses. He wasn’t taking any. If he had taken all four as prescribed he likely would have had a severe hypotensive episode.

Question 12

What are Beers criteria?

Answer 12

It is a system maintained by the American Geriatric Society that tells providers what adverse events to expect in the elderly based on grade and likelihood.

Question 13

What are the top drugs to avoid in the elderly?

Answer 13

• Clonidine
• Diphenhydramine
• Hydroxyzine
• TCAs
• Amiodarone
• Benzodiazepines
• Digoxin

Question 14

TCAs block the reuptake of ______________.

Answer 14

serotonin and norepinephrine (not dopamine)

Question 15

Which drugs commonly need to be tapered?

Answer 15

Clonidine and TCAs (abrupt stop of TCAs can lead to rebound cholinergic syndrome and abrupt stop of clonidine can lead to rebound hypertension)

Question 16

The ___________ trial showed that those older than 80 with BP greater than 160/90 benefited from antihypertensive treatment.

Answer 16

HYVET

Question 17

One of the limitations of the HYVET study was ____________.

Answer 17

that the bulk of the patients came from eastern Europe where stroke rates are higher

Question 18

What was the NNT in the HYVET study?

Answer 18

100 (that is, for every one hundred people treated, one fewer stroke occurred)

Question 19

Liver metabolism decreases due to ______________.

Answer 19

decreased blood flow and size of liver

Question 20

Why is the Cockroft-Gault equation useful?

Answer 20

Serum creatinine is less indicative of creatinine clearance in older adults because older adults make less creatinine. As such, an older adult might have a “normal” creatinine level even with poor creatinine clearance.

Question 21

The STOPP study found that half of hospitalizations had been ____________.

Answer 21

partially caused by ADRs

Question 22

One clinical pearl: __________ can result from drugs that are not the “usual culprits.”

Answer 22

drug-induced Parkinsonism

Question 23

The American Geriatric Society recommends that doctors not prescribe a medication without _______________.

Answer 23

performing a medication review

Question 24

There is a _____-day high-risk period for falls after prescription of a new antihypertensive.

Answer 24

45

Question 25

Some studies have shown that antihypertensive treatment leads to an increased ____________.

Answer 25

rate of cognitive decline

Question 26

Some research has shown that ____________ is the best predictor of prognosis regarding frailty.

Answer 26

gait speed (with less than 0.8 m/s considered high-risk for frailty)