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Pharmacology Quiz 2 > Geriatrics > Flashcards

Geriatrics Flashcards

1
Q

How is gastric pH affected in geriatric patients?

A

Gastric pH may rise changing ionization

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2
Q

How is passive absorption affected in geriatric patients?

A

Complete but slower

Increased by longer GI transit time

increase in epithelial permeability

Reduced perfusion

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3
Q

What are some changes in the distribution of drugs in geriatric patients?

A

Increase in membrane permeability and passive transport

Tissue perfusion may decrease with age

Dysfunction of blood-brain barrier may change volume of distribution

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4
Q

How much is hepatic flow reduced in older patients?

A

Hepatic blood flow reduced 30 to 50%

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5
Q

How is protein binding affected in older patients?

A

Decreased albumin, increased alpha1- acid glycoprotein

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6
Q

What type of drugs does albumin bind?

A

Acidic and neutral

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7
Q

What type of drugs does alpha1- acid glycoprotein bind?

A

Basic

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8
Q

A 80 year Patient with decreased albumin needs an acidic drug, do you decrease or increase the does?

A

Decrease

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9
Q

What Phase of drug metabolism is decreased in older patients?

A

Phase I

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10
Q

What Phase of drug metabolism is preserved in older patients?

A

Phase II

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11
Q

How is the GFR affected in elderly patients?

A

Decreased 15 to 40% and effective renal plasma flow reduction of about 10% per decade of life from young adulthood to age 80

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12
Q

An elderly patient comes in with a decreased creatinine clearance. What might you need to adjust to maintain steady state?

A

Dosing intervals

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13
Q

In the elderly drugs will take ______ to reach steady state

A

longer

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14
Q

In the elderly it will take _______ for drugs to be eliminated after discontinuation

A

longer

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15
Q

A decrease in creatinine clearance will mean an increase in _________?

A

half -life

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16
Q

An increase in ____________ will mean an increase in half-life

A

volume of distribution

17
Q

T or F - in the elderly there is a reduction in cardiac and vascular beta-adrenergic responsiveness.

How does this affect the beta blocking effects of drugs?

A

True - Less sensitive to beta blocking effects of drugs

18
Q

In regards to the CNS, are agents generally more or less effective in elderly patients?

A

Less effective - and adverse reactions are greater

19
Q

How are the frail elderly characterized?

A

High susceptibility to disease
Impending decline in physical function
High risk of death
Measured through

  • Mobility (walk time)
  • Strength (grip strength)
  • Nutrition (weight loss)
  • Endurance (exhaustion)
  • Physical activity
20
Q

The frail elderly have increased rates of ADR’s with significant morbidity and mortality due to?

A

Less physiologic reserve

Polypharmacy

Adherence issues related to cognitive and sensory impairment

Frequent admissions to the hospital because of increased susceptibility to disease

21
Q

What is medication reconciliation?

A

going through a patients drugs and removing uneeded ones

22
Q

When reconciling medication what are some appropriate questions to ask?

A
  • Is there an indication for the drug?
  • Is the medication effective for the condition?
  • Is the dosage correct?
  • Are the directions correct?
  • Are the directions practical?
  • Are there clinically significant drug-drug interactions?
  • Are there clinically significant drug-disease interactions?
  • Is there unnecessary duplication with other drugs?
  • Is the duration of therapy acceptable?
  • Is this drug the least expensive alternative compared with others of equal usefulness?
23
Q

What is the PIM (Beers) list?

A

potentially inappropriate medications - Follows evidence-based approach of the Institute of Medicine

24
Q

What are the two categories of PIM?

A

Medications to avoid regardless of diseases or conditions

Medications considered potentially inappropriate when used with certain diseases or conditions

  • A third group, medications that should be used with caution
25
Q

Importance of PIM criteria?

A

Strong link in the literature between Beers Criteria drugs and poor patient outcomes

PIMs have limited effectiveness and associated with problems like:

  • Fractures
  • Falls
  • Delirium
  • Gastrointestinal bleeding
26
Q

Anticholinergics

A

Don’t Use in elderly patients

27
Q

What type of patients have problems with hepatic clearance even if AST and ALT levels are normal

A

Alcoholics

28
Q

What is the narrow therapeutic index?

A

Poison dose and maximum effective dose are close. Any variation can have bad effects.

Ex. seizure drugs, anticoagulants, chemotherapy drugs

Pharmacology Quiz 2 (4 decks)

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