Geriatric Pharmacology

Question 1

what are the chances in body composition with aging?

Answer 1

dec muscle size and mass

reduction in water and lean muscle

increased body fat %

Question 2

what are the GI changes in aging?

Answer 2

dec fxn of gastroesophageal sphincter

dec gastric acid secretion and emptying

thinning of GI mucosa

dec liver size and blood flow

Question 3

what are the changes in the genitourinary system with aging?

Answer 3

Dec renal mass and glomeruli

changes in bladder

Question 4

what are the chances in the CV system with aging?

Answer 4

fibroelastic thickening

dec baroreceptor sensitivity

Question 5

what are the neuromuscular and musculoskeletal changes with aging?

Answer 5

Dec brain volume

more permeable BBB

dec bone mineral density

dec in homeostatic control

Question 6

what is the consequence of increased body fat in aging?

Answer 6

increased storage of lipid soluble drugs

Question 7

what is the consequence of decreased plasma proteins in aging?

Answer 7

increased water soluble drugs free floating leads to an increase in their effects

Question 8

what leads to altered drug absorption in aging?

Answer 8

dec gastric acid

dec stomach emptying

dec absorbing area

dec motility

Question 9

what contributes to altered drug distribution in aging?

Answer 9

dec water

inc body fat

dec lean body mass

dec plasma proteins

Question 10

what contributes to changes in hepatic metabolism in aging?

Answer 10

dec liver mass

dec liver blood flow

dec enzyme activity

Question 11

what contributes to changes in renal excretion in aging?

Answer 11

dec kidney mass

dec kidney blood flow

dec tubular fxn in nephron

Question 12

what are the 3 pharmacodynamic changes w aging?

Answer 12

1) changes in drug receptor affinity

2) changes in coupling mechanism

3) changes in biochemical events

Question 13

what are the pharmacodynamic changes w Ca2 channel blockers in aging?

Answer 13

inc sensitivity to vasodilation

dec HR and BP

Question 14

what are the pharmacodynamic changes w beta blockers in aging?

Answer 14

reduced beta adrenergic receptors fxn

reduced responses to beta antagonists

dec therapeutic effect w/beta blockers

Question 15

what are the pharmacodynamic changes w anticoagulants in aging?

Answer 15

greater inhibition of synthesis of clotting factors

greater risk of bleeding

Question 16

what are the pharmacodynamic changes w anticholinergics in aging?

Answer 16

impaired cognition in pts w/cholinergic deficit

Question 17

what are the pharmacodynamic changes w bezos in aging?

Answer 17

inc postural sway

stronger sedative effects

Question 18

what are the pharmacodynamic changes w anesthetic agents in aging?

Answer 18

inc sensitivity to propofol and opioids

Question 19

what are the pharmacodynamic changes w antipsychotics in aging?

Answer 19

inc effects

extrapyramidal symptoms, arryhthmias, postural hypotension

Question 20

in aging is the response to beta-agonists increased or decreased?

Answer 20

decreased

Question 21

in aging is the response to beta blockers increased or decreased?

Answer 21

decreased

Question 22

in aging is the response to Ca2+ channels blockers increased or decreased?

Answer 22

increased

Question 23

in aging is the response to loop diuretics increased or decreased?

Answer 23

decreased

Question 24

in aging is the response to vit K antagonists increased or decreased?

Answer 24

increased

Question 25

in aging is the response to morphine increased or decreased?

Answer 25

increased

Question 26

in aging is the response to propofol increased or decreased?

Answer 26

increased

Question 27

in aging is the response to antipsychotics increased or decreased?

Answer 27

increased

Question 28

in aging is the response to benzos increased or decreased?

Answer 28

increased

Question 29

there is a greater variability in drug responses due to changes in ...

Answer 29

organ fxn body comp fragility comorbidity pharmacogenetic factors (genotypes)

Question 30

what is polypharmacy?

Answer 30

5 or meds taken daily

Question 31

polypharmacy increases the risk of...

Answer 31

drug interactions overdose toxicity dosing errors

Question 32

what are characteristics of polypharmacy in older adults?

Answer 32

use of meds for no reason use of duplicate meds concurrent use of interacting meds use of contrindicated meds use of inappropriate dosage use of drug therapy to Rx adverse drug rxns

Question 33

what are the s/s of common adverse drug rxns?

Answer 33

GI symptoms sedation confusion depression OH fatigue and weakness dizziness and falls anticholinergic effects extrapyramidal symptoms

Question 34

what are other factors that increase the risk of adverse drug reactions in older adults?

Answer 34

comorbidities lack of proper drug testing w/older subjects lack of pt education nonadherence to drug regimen use of inappropriate meds

Question 35

what is Beer's criteria?

Answer 35

a list of drugs that are likely to make the pt more confused, inc fall risk, inc likelihood of side effects/toxicity pts should be adequately monitored and benefits should outweigh the risks