Flashcards in Pharmacology and Aging Deck (79):
What is the BEERs criteria?
Listing of drugs that should not be used in the elderly
True or false: formulations change frequently
What are nutraceuticals?
What are the four factors of pharmacokinetics?
True or false: amount absorbed (bioavailability) is not changed in the elderly
What happens to peak concentrations in the elderly? What are the exceptions to this?
Lower and delayed
Extensive first pass effect
What are the factors that affect drug absorption? (4)
What taken with
What is the effect of divalent cations on drug absorption?
Affect absorption of fluoroquinolones
Enteral feedings interfere with what?
Absorption of some drugs
What type of drugs particularly affect absorption?
Drugs that affect GI motility
Decreased body water has what effect on drug absorption?
Lower VD for hydrophilic drugs
Decreased lean body mass has what effect on drug absorption?
Lower VD for drugs that bind muscle
Increased fat stores has what effect on drugs?
Higher VD for lipophilic drugs
Decreased plasma protein (albumin) has what effect on drugs?
Higher percentage of drug that is unbound
Generally, men or women metabolize drugs faster?
What is the effect of smoking on drug clearance?
Increases clearance for some drugs
CHF has what effect on the liver?
Hepatic congestion (lowered metabolism)
What is half-life?
Time for serum [c] of drug to decline by 50%
What is drug clearance?
Volume of serum from which the drug is removed per unit of time (L/hour or mL/min)
What is the most common reason for A-fib?
Smoking increases the clearance of what drug in particular?
Most drugs exit the body through what route?
What is the consequence of reduced elimination of drugs through the kidneys?
Drug accumulation and toxicity
What are four factors of the kidneys decrease in old age?
Renal tubular secretion
What is the first system that is usually effected d/t bad drug interactions?
What is the drug that is hard on the kidneys?
Lower body mass does what to creatinine clearance? GFR?
What are the two ways to determine creatinine clearance?
Measure (24 hr urine collection)
Estimate (cockroft-gault equation)
Is an 8 hour creatinine clearance acceptable?
What is the equation for the cockroft gault equation?
[(Ideal weight)(140-age) / 72(serum Cr)] * 0.85 if female
In pts without a significant age related decline in renal function, is CrCl under or overestimeated?
What is the major issue with Benzos?
Increases fall risk
True or false: older pts may experience longer pain relief with morphine
True or false: Benzos should not be used for sleep. Explain.
What are the four factors that are needed for successful pharmacotherapy?
Correct drug, dose, condition
Is appropriate for pt
ADEs are responsible for what percent of acute geriatric hospital admission?
What percent of ADEs occur in community dwelling older adults?
What are the most common drugs that cause ADEs? (5)
What general characteristic of a drug is associated with ADEs?
Ones with narrow margin of safety
What food is bad for CHF pts?
What percent of ambulatory adults receive at least one potentially inappropriate med?
What can underprescribing result from?
Assuming older adults will not benefit from
Meds intended as prim or sec prevention
What is the most common drug that causes drowsiness?
ACE inhibitors usually cause what?
Long term beta blocker use can cause what?
How many concurrent chronic conditions are a risk factor for ADEs?
6 or more
How many doses of drugs/day are a risk factor for ADEs?
12 or more
How many meds are a risk factor for ADEs?
9 or more
True or false: prior adverse drug events are not a risk factor for ADEs
What age is considered a risk factor for ADEs?
What is the CrCl that is a risk factor for ADEs?
What are the most common drug-drug interactions?
Cardio and psychotropics
What is the pathway that is utilized in drug metabolism?
What are the symptoms of drug-drug interactions? (4)
Acute renal failure
What should you consider before adding a drug?
Is this used to treat side effects of another drug?
What are the two things that cause nonadherence to drugs?
Failure of dr to consider pts situation
Pts not understanding
Over prescribed or under-prescribed: Antiinfective agents
Over prescribed or under-prescribed: anticholinergic agents
Over prescribed or under-prescribed: ACE inhibitors for pts with DM and proteinuria
Over prescribed or under-prescribed: angiotensin-receptor blockers
Over prescribed or under-prescribed: Urinary and GI antispasmodics
Over prescribed or under-prescribed: antipsychotics
Over prescribed or under-prescribed: Benzos
Over prescribed or under-prescribed: antigoagulants
Over prescribed or under-prescribed: antihypertensive agents and diuretics for uncontrolled HTN
Over prescribed or under-prescribed: digoxin for diastolic dysfuntion
Over prescribed or under-prescribed: dipyridamole
Over prescribed or under-prescribed: H2 receptor agonist
Over prescribed or under-prescribed: laxatives and fecal softeners
Over prescribed or under-prescribed: beta blocks for pts after an MI
Over prescribed or under-prescribed: bronchodilators
Over prescribed or under-prescribed: PPIs for GI protection from NSAIDs
Over prescribed or under-prescribed: statins
Over prescribed or under-prescribed: NSAIDs
Over prescribed or under-prescribed: PPIs
Over prescribed or under-prescribed: Sedating antihistamines
Over prescribed or under-prescribed: TCAs
Over prescribed or under-prescribed: vitamins and minerals