Pharmacology and Aging Flashcards Preview

Geriatrics > Pharmacology and Aging > Flashcards

Flashcards in Pharmacology and Aging Deck (79):
1

What is the BEERs criteria?

Listing of drugs that should not be used in the elderly

2

True or false: formulations change frequently

True

3

What are nutraceuticals?

Herbal preps
Nutritional supplements
etc

4

What are the four factors of pharmacokinetics?

Absorption
Distribution
Metabolism
Elimination

5

True or false: amount absorbed (bioavailability) is not changed in the elderly

True

6

What happens to peak concentrations in the elderly? What are the exceptions to this?

Lower and delayed

Extensive first pass effect

7

What are the factors that affect drug absorption? (4)

Route
What taken with
Comorbidities
Gastric pH

8

What is the effect of divalent cations on drug absorption?

Affect absorption of fluoroquinolones

9

Enteral feedings interfere with what?

Absorption of some drugs

10

What type of drugs particularly affect absorption?

Drugs that affect GI motility

11

Decreased body water has what effect on drug absorption?

Lower VD for hydrophilic drugs

12

Decreased lean body mass has what effect on drug absorption?

Lower VD for drugs that bind muscle

13

Increased fat stores has what effect on drugs?

Higher VD for lipophilic drugs

14

Decreased plasma protein (albumin) has what effect on drugs?

Higher percentage of drug that is unbound

15

Generally, men or women metabolize drugs faster?

Men

16

What is the effect of smoking on drug clearance?

Increases clearance for some drugs

17

CHF has what effect on the liver?

Hepatic congestion (lowered metabolism)

18

What is half-life?

Time for serum [c] of drug to decline by 50%

19

What is drug clearance?

Volume of serum from which the drug is removed per unit of time (L/hour or mL/min)

20

What is the most common reason for A-fib?

HTN

21

Smoking increases the clearance of what drug in particular?

Theopylline

22

Most drugs exit the body through what route?

Kidney

23

What is the consequence of reduced elimination of drugs through the kidneys?

Drug accumulation and toxicity

24

What are four factors of the kidneys decrease in old age?

Size
RBF (GFR)
Nephrons
Renal tubular secretion

25

What is the first system that is usually effected d/t bad drug interactions?

GI system

26

What is the drug that is hard on the kidneys?

IV/oral contrast

27

Lower body mass does what to creatinine clearance? GFR?

Lowers

28

What are the two ways to determine creatinine clearance?

Measure (24 hr urine collection)

Estimate (cockroft-gault equation)

29

Is an 8 hour creatinine clearance acceptable?

No

30

What is the equation for the cockroft gault equation?

[(Ideal weight)(140-age) / 72(serum Cr)] * 0.85 if female

31

In pts without a significant age related decline in renal function, is CrCl under or overestimeated?

Under

32

What is the major issue with Benzos?

Increases fall risk

33

True or false: older pts may experience longer pain relief with morphine

True

34

True or false: Benzos should not be used for sleep. Explain.

True--addicting

35

What are the four factors that are needed for successful pharmacotherapy?

Correct drug, dose, condition

Is appropriate for pt

36

ADEs are responsible for what percent of acute geriatric hospital admission?

5-28%

37

What percent of ADEs occur in community dwelling older adults?

35%

38

What are the most common drugs that cause ADEs? (5)

Cardio
Diuretics
NSAIDs
Hypoglycemics
Anticoags

39

What general characteristic of a drug is associated with ADEs?

Ones with narrow margin of safety

40

What food is bad for CHF pts?

BBQ (salt)

41

What percent of ambulatory adults receive at least one potentially inappropriate med?

>20%

42

What can underprescribing result from?

Assuming older adults will not benefit from

Meds intended as prim or sec prevention

Aggresive

43

What is the most common drug that causes drowsiness?

Benadryl

44

ACE inhibitors usually cause what?

Cough

45

Long term beta blocker use can cause what?

Depression

46

How many concurrent chronic conditions are a risk factor for ADEs?

6 or more

47

How many doses of drugs/day are a risk factor for ADEs?

12 or more

48

How many meds are a risk factor for ADEs?

9 or more

49

True or false: prior adverse drug events are not a risk factor for ADEs

False

50

What age is considered a risk factor for ADEs?

85+

51

What is the CrCl that is a risk factor for ADEs?

52

What are the most common drug-drug interactions?

Cardio and psychotropics

53

What is the pathway that is utilized in drug metabolism?

CYP3A4 (p450)

54

What are the symptoms of drug-drug interactions? (4)

Confusion/delirium
Cognitive impairment
Hypotension
Acute renal failure

55

What should you consider before adding a drug?

Is this used to treat side effects of another drug?

56

What are the two things that cause nonadherence to drugs?

Failure of dr to consider pts situation

Pts not understanding

57

Over prescribed or under-prescribed: Antiinfective agents

Over

58

Over prescribed or under-prescribed: anticholinergic agents

Over

59

Over prescribed or under-prescribed: ACE inhibitors for pts with DM and proteinuria

Under

60

Over prescribed or under-prescribed: angiotensin-receptor blockers

Under

61

Over prescribed or under-prescribed: Urinary and GI antispasmodics

Over

62

Over prescribed or under-prescribed: antipsychotics

Over

63

Over prescribed or under-prescribed: Benzos

Over

64

Over prescribed or under-prescribed: antigoagulants

Under

65

Over prescribed or under-prescribed: antihypertensive agents and diuretics for uncontrolled HTN

Under

66

Over prescribed or under-prescribed: digoxin for diastolic dysfuntion

Over

67

Over prescribed or under-prescribed: dipyridamole

Over

68

Over prescribed or under-prescribed: H2 receptor agonist

Over

69

Over prescribed or under-prescribed: laxatives and fecal softeners

Over

70

Over prescribed or under-prescribed: beta blocks for pts after an MI

Under

71

Over prescribed or under-prescribed: bronchodilators

Under

72

Over prescribed or under-prescribed: PPIs for GI protection from NSAIDs

Under

73

Over prescribed or under-prescribed: statins

under

74

Over prescribed or under-prescribed: NSAIDs

Over

75

Over prescribed or under-prescribed: PPIs

Over

76

Over prescribed or under-prescribed: Sedating antihistamines

Over

77

Over prescribed or under-prescribed: TCAs

over

78

Over prescribed or under-prescribed: vitamins and minerals

Over

79

Over prescribed or under-prescribed: vitamin D

Under