Exam 11: Geriatric Pharm Flashcards Preview

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Flashcards in Exam 11: Geriatric Pharm Deck (24):
1

GI effects of aging

Reduced cell regeneration and muscle tone
Slower digestion, greater residence time
Greater risk of malabsorption and constipation

2

Liver effects of aging

20-40% size reduction over time
Less blood flow
Lower CYP 450 concentrations
Slower hepatic clearance of drugs

3

Cardiovascular effects of aging

50% decrease in flow to kidneys
20% decrease in flow to the brain
Orthostatic and postprandial hypotension
Resting HR and CO are stable
Stiffening of aorta (increased systolic BP)

4

Brain effects of aging

Shrinks
less blood flow
More permeable BBB
Reduced DA, 5-HT, glutamate, ACh signaling

5

Effects of aging on kidneys

Reduced blood flow (10%/decade)
Reduced GFR (1%/year after 30)
Proteinuria is NOT NORMAL

6

Why isn't creatinine clearance reliable in the elderly to measure GFR?

Reduced lean body mass results in lower Cr clearance without affecting the actual GFR

7

How does aging affect Vd?

More fat, less water:
Longer half-lives of lipophilic drugs
Increased concentrations of water soluble drugs

8

How does aging affect protein bound drugs in frail, sick patients?

Increased free concentrations because they have less albumin

9

What type of liver metabolism is reduced with age? Unchanged/

Reduced oxidative metabolism
Unchanged conjugative metabolism

10

How is drug elimination at the kidneys effected by age?

Less GFR
Less tubular secretion

11

NSAIDs and aging?

can hurt kidneys

12

Anticholinergics and aging

cognitive impairment
psychosis
tachycardia

13

Benzos and aging

They're more sensitive to benzos
Cognitive decline and falls

14

ACE inhibitors and aging

Impaired renal clearance leads to longer half life
Hypotension/hyperkalemia

15

Prescribing cascade

phenomenon when you prescribe drugs to treat drug side effects and then have to prescribe other drugs to treat the side effects of those drugs and so on

16

How should you use Beers list and Canadian criteria list (CCL)

they're just tools for reducing adverse drug events
Dont let them get in the way of giving the patient the best personalized therapy

17

4 medications associated with adverse drug effects in the elderly?

Opioids
NSAIDs
Anticholinergics
Benzos

18

Why do we need to be careful with opioids in the elderly?

Decreased GFR
Reduced liver function
Phase I reaction impairment
Side effects increased

19

Concerns with Benzos in the elderly

more sensitive
more sedation, unsteadiness, memory loss
falls, vehicular accidents
sensitivity may be due to GABAa receptors

20

Dosing benzos in the elderly

cut the dose in half
use drugs with short half-lives

21

2 benzos appropriate for use in patients with decreased liver function

Lorazepam
Oxazepam

22

2 drugs with increased serum levels when taken with benzos

Digoxin and phenytoin

23

grapefruit juice effects on drugs

Can cause either overdose or reduced dose depending on the drug metabolism

24

SAIL mnemonic

Simple (keep the drug regimen simple)
Adverse effects (understand them)
Indication (is there a clear reason for giving the drug)
List (give patients a list of their drugs)