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Flashcards in Gero Deck (16):
1

gero physiologic changes

less lean body mass, inc body fat
loss of skeletal bone mass
atrophy of the thyroid gland
decrease in cell mediated immunity
reduction in cardiac output with activity
dec. lung tissue elasticity and strength of resp muscles
dec in renal blood flow and GFR
dec in GI motility and acid production
hepatic blood flow and liver mass are reduced
changes in sensory: vision, hearing, taste, thirst

2

gero metabolism changes

dec. first pass metabolism, minor changes in phase I metabolism, unchanged phase II metabolism
net effect - inc bioavail of drugs with ext. first pass metabolism and inc half life of drugs that are metabolized by phase I
no longer metabolising in GI tract (less enzyme) therefore high toxicity and levels

3

PK absorption changes

dec. gatric acidity, motility.
net effect- bioavailability of most drugs are not altered

4

PK changes in distribution

dec total body water, lean body mass, plasma albumin, inc adipose tissue
net effect - inc in serum conc of hydrophilic drugs anddrugs that distribute to lean body mass
dec protein binding will leat to inc in free drug
delay clearance of lipophillic drugs

5

PK elimination changes

dec renal blood flow and GFR
net effect - inc half life of drugs with predominant renal elimination

6

PD changes - less sensitive to/ more sensitive to

less sensitive to: beta receptors, baroreceptors, insulin receptors
more sensitive to: centrally acting drugs (narcotics, neuroleptics, antidepressants, benzodiazepines)

7

high risk meds with QTc interval prolongation

amiodarone, quinolones, macrolides, haloperidol (IV), ziprasidone, TCAs, antihistaines, methadone

8

high risk drugs with narrow therapeutic index

lithium, warfarin, digoxin

9

high risk drugs with anticholinergic effects

GI antispasmotics, GU drugs, Parkinson's drugs, TCAs, trazodone, loperamide, antipsychotics, bronchodilators, atropeine
r/f confusion, urinary retention, dry mouth

10

high risk meds that are sedating

anticonvulsants, atypical antipsychotics, benzodiazepines, muscle relaxants, opioids, fluoxetine, TCA

11

high risk meds for hypoglycemia

insulin, sulfonylureas, TZD (pioglitazone/rosiglitazone) metformin (r/f lactic acidosis)
insulin eliminated by metabolization in kidneys, requirement goes down

12

adverse drug events, ER visits d/t meds

warfarin, insulin, digoxin, antiplatelets, oral hypoglycemics, narcotics, antibiotics

13

top drug-drug interactions

warfin/other anticoag and NSAID
warfarin and TMP/SMZ (bleeding)
ACE i - K supplement
ACE i and sprionolactone
ACEi and TMP/SMZ
Warfarin and Cipro
Digoxin and Amiodarone - av block, asystole, heart block, dig toxicity, same as verapamil
DIgoxin and verapamil
- rash and hyperkalemia
Thyroid and Iron (or cipro)-chelating
SSRI and tramadol
HMG-CoA reductase inhibitor, gemfibrozil and erythromycin or itraconazole (myositis, rhabdo)

14

food-drug/ nutrient interactions

phentoin - dec folate
metformin - dec Vit B12
isoniazid - dec. Vit B6
phenytoin - dec absorption with NG feedings
levodopa - high protein meals effect blood-brain transport
Catopril - altered taste sensation

15

renal insufficiency (eGFR)

normal 90-150
decreased 60-90
mild 3015-60
moderate 15-30
uremia/severe renal failure <

16


Creatinine Clearance

Cockcroft-Gault formula:
crCl(m./men)=(140-age[yrs])x weight[kg]/SCr x 72

for women CrCl x 0.85