Oldies

Question 1

Most common drug classes used by older adults

Answer 1

analgesics, diuretics, cardiovascular drugs, and sedative hypnotics

Question 2

What happens to absorption in older adults?

Answer 2

Reduced GI blood flow and motility
Reduced gastric acidity
Reduced absorptive surface from microvilli atrophy

Question 3

Which drugs tend to have a reduced absorption in the elderly?

Answer 3

drugs (levodopa, propylthiouracil) whose chemical structures are similar to endogenous substances (sugars, amino acids, peptides, iron salts) requires active transport

Question 4

What happens to the first-pass effect in the elderly?

Answer 4

reduction of hepatic first-pass effect may lead to increased bioavailability

Question 5

What happens to fluid volume in the elderly?

Answer 5

Total body water and extracellular fluid volume decrease with age and the of total body fat rises

Question 6

What can happen with water soluble drugs in the elderly?

Answer 6

water-soluble drugs have a reduced volume of distribution, leading to increased plasma concentrations of hydrophilic (water-soluble) drugs such as lithium

Question 7

Lipophilic drugs in the elderly result in what?

Answer 7

Because body fat increases with age, lipophilic (lipid-soluble) drugs will have an increased half-life from increased storage in fatty tissue - need to be adjusted

Question 8

What happens to drugs in hypoalbuminemia?

Answer 8

Because of hypoalbuminemia, the free or unbound fraction increases, thereby increasing the drug’s effect

Question 9

Hypoalbuminemia + phenytoin

Answer 9

With hypoalbuminemia, the therapeutic range for phenytoin becomes substantially lower

Question 10

What happens with serum Cr in the elderly?

Answer 10

Because older adults have reduced muscle mass, the serum Cr may be falsely low as an indicator of GFR

Question 11

What happens to the CrCl formula in the elderly?

Answer 11

May be falsely low d/t the falsely low serum Cr

Question 12

If serum Cr is < 1 what should be done in the elderly?

Answer 12

Round up to 1 when calculating CrCl

Question 13

How do elderly react to furosemide and BB and B agonists?

Answer 13

Because older adults have reduced muscle mass, the serum Cr may be falsely low as an indicator of GFR

Question 14

What is a common SE of tx HTN in the elderly?

Answer 14

Orthostatic hypotension

Question 15

What is the first tx option in older adults in tx HTN?

Answer 15

Low dose diuretic or ACE inhibitor (prils)

Question 16

What is the (ALLHAT, 2006) trial outcome?

Answer 16

Thiazide diuretic was superior in preventing these outcomes

Question 17

What is the most effective tx of HTN in the elderly?

Answer 17

low-dose diuretics are most effective first-line treatment for treating HTN in older adults

Question 18

BB vs diuretics in the elderly

Answer 18

diuretic therapy is superior in preventing vascular events

Question 19

Major SE of CCB in the elderly?

Answer 19

peripheral edema

Question 20

What is 2nd line in tx HTN in the elderly?

Answer 20

ACE Inhibitors/ ARBs

Question 21

What to watch out for in ACE Inhibitors/ ARBs?

Answer 21

Chronic cough

Question 22

MC neuroleptics used to help tx dementia

Answer 22

haloperidol (Haldol), risperidone (Risperdal), and quetiapine (Seroquel)

Question 23

Which benzo is typically used in the elderly if necessary to tx delirium?

Answer 23

Lorazepam (Ativan) has wide acceptance because it is short-acting

Question 24

Cholinesterase Inhibitors (ChEs) examples

Answer 24

donepezil
rivastigmine
galantamine

Question 25

Mild and moderate tx for DA

Answer 25

Rivastigmine and galantamine are FDA approved for the treatment of both the mild and moderate stages of Alzheimer’s Disease

Question 26

Which ChE is approved to tx all 3 stages of AD?

Answer 26

Donepezil is approved for all three stages of Alzheimer’s Disease—mild, moderate, and severe

Question 27

Which drugs should be avoided in pts on ChE?

Answer 27

avoid drugs with anticholinergic side effects, such as antihistamines or antimuscarinic drugs used for urinary incontinence (oxybutynin)

Question 28

In which pts should ChEs be used in w/ caution?

Answer 28

Further caution in patients with cardiac disorders Caution should be taken in patients with problems urinating

Question 29

NMDA Inhibitor: Memantine (Namenda) MOA

Answer 29

Inhibits N-methyl-D-aspartate channels

Question 30

What type of AD is Memantine approved to tx?

Answer 30

FDA approved for patients with moderate and severe Alzheimer’s Disease, not the mild stage

Question 31

Memantine SE

Answer 31

dizziness, headache, confusion, coughing, somnolence, pain, vomiting, and hallucinations

Question 32

Muscarinic Antagonists examples

Answer 32

Oxybutin Trospium

Question 33

Muscarinic Antagonists MOA

Answer 33

All are reversible acetylcholine receptor blockers that block the muscarinic or parasympathetic nerve endings on the detrusor muscle of the bladder

Question 34

Use of muscarinic antagonists

Answer 34

For urge incontinence in cognitively intact patients Not indicated for nonspecific incontinence or other types of UI

Question 35

What should Muscarinic antagonists NOT be combined with?

Answer 35

Do not combine cholinesterase inhibitors (such as donepezil) with these drugs because they have opposing mechanisms of action

Question 36

In which pts should muscarinic antagonists be avoided in?

Answer 36

Pts with AD

Question 37

Amiodarone can cause a serious drug interaction when combined with?

Answer 37

Serious drug interactions with digoxin and warfarin

Question 38

What is the MC use for warfarin?

Answer 38

chronic nonvalvular atrial fibrillation

Question 39

Which drugs can cause parkinsonism in older adults?

Answer 39

Antihistamine/antinauseants: promethazine (Phenergan), prochlorperazine (Compazine), and metoclopramide (Reglan) Antipsychotics

Question 40

Parkinsonism tx

Answer 40

D/c drug and carbidopa-levadopa

Question 41

Antipsychotics Black Box warning in the elderly

Answer 41

Increased mortality in elderly w/ dementia related psychosis

Question 42

Which benzos should be avoided in the elderly?

Answer 42

Avoid use of the following long-acting benzodiazepines: Diazepam (Valium) Chlordiazepoxide (Librium) Chlorazepate (Tranxene) Flurazepam (Dalmane)

Question 43

What should be checked in older adults on steroids?

Answer 43

All older adults on chronic steroids should have assessment of bone density and receive adequate calcium and vitamin D

Question 44

Which NSAID should be avoided in the elderly?

Answer 44

Celecoxib