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Flashcards in older adults Deck (44):
1

why is the study of pharmacology critical in older patients

because they have the highest percentage of prescriptions, there are many off-label uses, there are many interactions.

2

does the bioavailibility change with age

no

3

does the peak serum concentration change with age

yes. could be lowre or delayed.

4

what must be kept in mind when considering the serum concentration of an older person

drugs that have first pass effect. their bioavailability may increase because there is less liver and blood flow. this is contradictory to the above card.

5

what can the affect the absorption of drugs

divalent cations, enteral feedings, increased gastric pH, drugs that effect GI motility.

6

what drug is specifically affected by cation

ciprofloxacin -quinolones

7

what drug is specifically affected by enteral feedings

phenytoin

8

what are the effects of aging of distribution

decreased body water means lower VD for hydrophilic drugs.
decreased lean mass means lower VD for muscle bound
increased fat stores means higher VD for lipophilic
decreased plasma protein means a higher percentage of the drug is unbound

9

why would metabolic clearance by the liver be decreased

aging decreases the blood flow, size, and mass of liver,

10

what are the phase I paths

oxidation, hydroxylation, dealkylation, reduction.

11

what does the phase I do

converts drugs to metabolites with greater, lesser or the same effect as the parent compound

12

phase II paths

convert drugs to inactive metabolites that do not accumnulate.

13

what phase metabolism drugs are preferred for older patients

phase II drugs.

14

examples of protein bound drugs

warfarin, barbiturates, phenytoin, carbamezapine

15

examples of phase I drugs

long acting benzodiazepam

16

examples of water soluble drug

digoxin, lithium

17

exampes of lipid soluble drugs

diazepam

18

can gender effect the metabolism of a drug

yes

19

what is the half-life

time for serum conc to decline by 50%

20

what is the clearance

volume of serum for which the drug is removed per unit time

21

where do most drugs exit the body

kidney . if there is reduced elimination there is accumulation and toxicity. aging can impair function

22

what are the effects of aging o n the kidneyh

decreased size, blood flow, number of functioning nephrons, renal tubular secretion. the result is lower GFR

23

does the serum Cr reflect the clearance in an older person

no. there is decreased lean mass, and decreased GFR so the range will stay in the normal masking changes.

24

how do we calculate the Cr clearance

need 24 hr collection to be accurate and cockroft and Gault equation.

25

what is the pharmacodynamics

time course and intensity of the pharmacological effects of a drug.

26

do the pharmacodynamics change with age

yes. likely by reduced clearance.

27

what are the most common medications that cause ADE

cardiovascular, CNS, MSK. meds that have a narrow therapeutic window.

28

what are the risks for ADE

6 or more concurrent chronic conditions
12 or more doses of drugs/day
9 or more meds
prior adverse reaction
low body weight or BMI
older than 85
CrCl<50

29

what are ADE misinterpreted as

new medical conditions

30

what are the risks for drug-drug interactions

increased number of medications consumed esp high risk, multiple prescribers, multiple pharmacies, physiologic and pharmacokinetic changes

31

what are the most common drug-drug interactions

cardiovascular and psychotropic

32

what are the key facts of drug drug

absorption can up or down, drugs with similar or opposite effects can result in changes in effect, drug metabolism can be induced or inhibited. herbals!

33

most common adverse affects of drug drug

confusion, cognitive impairment, arterial hypotension, acute renal failure.

34

ACEi and diuretic risk

hypotension and hyperkalemia

35

ACEi and potassium risk

hyperkalemia

36

antiarrhythmetic and diuretic risk

electrolyte imbalance and arrhythmias

37

benzo and antidepressant, antipsychotic, or benzo

confusion, sedation, falls,

38

CCB and diuretic or nitrate

hypotension

39

digatalis and antiarrhythmetic

bradycardia and arrhythmia

40

what is a drug-disease interaction

when a drug interacts with aberrant physiology of the patient

41

what is the interaction between obesity and lipophilic drugs

there is a greater VD.

42

what disease can affect hydrophilic drugs

ascites

43

what can dementia do to drugs

increase the sensitivity induce paradoxical reactions

44

what are the principles for prescribing to an older

start low and go slow. titrate upward slow. avoid starting 2 drugs