Geriatric pharmacology Flashcards Preview

Year 2 Pharmacology > Geriatric pharmacology > Flashcards

Flashcards in Geriatric pharmacology Deck (32):
1

what are four methods to prevent the prescribing cascade?

1. wait to confirm suspected diagnosis
2. start low and titrate up slowly
3. avoid starting multiple medications
4. reach therapeutic dose before switching or adding

2

what are three tools for medication decisions in older adults?

Beers Criteria
STOPP
START

3

what is STOPP used for?

to assess use of drug with specific patient with specific conditions

4

what is START used for?

to identify potential underuse of beneficial medications

5

what are the changes in body composition during the aging process?

decrease total body water
decrease lean body mass
increase body fat

6

what are the CV changes during the aging process?

decrease myocardial sensitivity to beta adrenergic stimulation
decrease baroreceptor activity
decrease CO
increase TPR

7

what are the liver changes during the aging process?

decrease hepatic size
decrease hepatic blood flow

8

what are the pulmonary changes during the aging process?

decrease respiratory muscle strength
decrease chest wall compliance
decrease total alveolar surface area
decrease vital capacity
decrease maximal breathing capacity

9

what are the renal changes during the aging process?

decrease GFR
decrease renal blood flow
decrease filtration fraction
decrease tubular secretion function
decrease renal mass

10

what are the skeletal changes during the aging process?

loss of skeletal bone mass

11

which variable of pharmacokinetics is least affected by aging?

absorption

12

which component of metabolism is decreased in the elderly?

first pass

13

in elderly patients with reduced first pass metabolism, should a higher or lower dose be used for a drug that is inactivated by first pass?

lower

14

in elderly patients with reduced first pass metabolism, should a higher or lower dose be used for a drug that requires activation by first pass?

higher

15

equation: volume of distribution

Vd = amount of drug in body / plasma drug concentration

16

what does a very large Vd indicate?

majority of drug distributes to the extravascular compartment

17

what does a small Vd indicate?

drug is retained primarily in the vasculature

18

gentamicin, a highly water soluble drug, will have what kind of Vd in the elderly? why?

decreased

less body water

19

would a highly lipid soluble drug have an increased or decreased half life in an elderly patient when compared to a younger patient? why?

no change in half life

decreased Vd of a highly water soluble drug tends to be balanced by a reduction in clearance

20

drugs bound to muscle have what kind of Vd in the elderly?

decreased

21

definition: clearance

rate of elimination of a drug from the body in relation to drug concentration

22

equation: clearance

CL = Q x E

23

in capacity limited clearance, what it the rate limiting step?

liver enzyme function

24

what is the rate limiting step in flow rate limited drugs?

how fast it can get to the liver cells (flow rate)

25

what is the effect of polypharmacy on tubular secretion, physiologically?

increases risk of drugs competing for active transporters

26

what molecule is an index of GFR?

creatinine

27

why is the cockcroft and gault equation significant for elderly patients?

accounts for decreased muscle mass in elderly (decreased creatinine)

28

what is the biggest effect of renal and hepatic clearance on half life?

increase

29

what are the pharmacodynamic changes with aging on the beta adrenergic system?

1. decreased cardiac and vascular responsiveness
2. decreased responsiveness of elderly individual to hypotensive effect of beta blockers

30

what is the effect of acute BP response to calcium channel blockers in elderly patients?

exaggerated

31

what is the effect of NSAIDs in the elderly population?

susceptible to toxicities (renal and hepatic)
GI bleeding and irritation

32

which drugs can significantly increase the risk of falls in the elderly? why?

anticholinergics

decreased cognition, sedation, orthostatic hypotension, blurry vision

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