Pharmacology and the Aged

Question 1

Those over the age of 65 make up what percentage of all prescriptions

Answer 1

30-35%

Question 2

Avg number of meds for someone in LTF

Answer 2

8

Question 3

Drug

Answer 3

Substance that alters cell function

Question 4

Side effect

Answer 4

Unwanted effects of drug

Question 5

Effect

Answer 5

Action of drug

What the drug does

Question 6

Adverse drug reaction

Answer 6

Undesirable or unwanted effect of drug

Question 7

Compliance

Answer 7

Taking drug as directed

Question 8

Pharmacodynamics

Answer 8

Study of affect of drugs at the target site (usually receptor)

Question 9

Pharmacokinetics

Answer 9

Study of time course of drug and metabolite levels in body fluids during absoprtion, distribuion, metablism, and elimination of drug

Question 10

Polypharmacy

Answer 10

Taking a number of drug

Question 11

How do normal age changes affect pharmacology

Answer 11

Altered drug deposition and metabolism 
Dec lean body mass
Inc body fat
Reduction in liver function
Dec in proteins in blood stream
Altered absorption
Reduces stomach acid
Reduces GI motility

Question 12

Altered Drug disposition and metabolism

Answer 12

Dec body weight
Dec lean body mass
Inc body fat
Dec total body water
Dec plasma albumin
Redstribution of regional blood flow

Question 13

Dec lean body mass - effect

Answer 13

There are fewer cells per unit of body weigth

Question 14

Dec lean body mass - importance

Answer 14

Drug dosages calculated on presumption of X number of cells per unit of body weigth

Question 15

Dec lean body mass - consequences

Answer 15

More drug per cell - more side effects, more toxicity, overdose
Need to recalculate dose for older adultd

Question 16

Significance of inc body fat

Answer 16

Larger volume for fat soluble drugs to distribute

Prolongs duration of some drugs

Question 17

Liver function - aging dec

Answer 17

The number of liver cells
Blood flow to the liver
Enzymes to break down drug

Question 18

COnsequences of liver function change

Answer 18

Drugs remain active for longer period of time

Inc drug concentration in blood

Question 19

Role of proteins

Answer 19

Bind and serve as a store

Prevent drug from being metabolized

Question 20

Concentration of proteins in aged adult

Answer 20

dec 15-25%

Question 21

Consequences of changes in proteins in blood stream

Answer 21

More free drug leads to more activity

Question 22

Concern of dec proteins in blood

Answer 22

Illness and poor nutrition will worse problem

Question 23

Altered absorption

Answer 23

Inc gastric pH
Dec splanchnic blood flow
Dec GI mobility
Delayed gastric emptying
Altered active transport

Question 24

Consequences of dec stomach acid

Answer 24

Reduced bioavailability of some tablets/capsules
Absoprtion of some drugs requires acid media
Altered rate of stomach emptying
Reduced drug absoprtion

Question 25

Consequences of reduction in GI motility

Answer 25

Less mixing of contents | Less exposing the drug to intestinal wall for absorption

Question 26

Net effect of reduction in GI motility

Answer 26

Delayed absoprtion | Irritating drugs do more damage

Question 27

Adverse drug reaction

Answer 27

Any undesirable or unintended drug effect Includes side effects Toxicity Allergic reaction

Question 28

Classification of types of ADRs

Answer 28

``` ABCDE Augmented drug effects Bizarre effects Chronic effects Delayed effects End ot tx effects ```

Question 29

Augmented drug effects

Answer 29

Dose related effects of drug | Bleeding due to anticoagulants

Question 30

Bizarre effects

Answer 30

Uncommon, unpredictable effects | Anaphylaxis due to penicillin

Question 31

Chronic effecs

Answer 31

Due to prolonged treatment (many doses) | Colic dysfunction due to laxatives

Question 32

Delayed effects

Answer 32

Adverse effect not related to initial reason for drug | Second type of cancers after therapy for initial cancer

Question 33

End of tx effects

Answer 33

Effects occur when drug is stopped

Question 34

Causes of drug toxicity in older adults - provider causes

Answer 34

Duplication of medications Imprecise directions Poor drug history

Question 35

Causes of drug toxicity in older adults - patient causes

Answer 35

``` Poor self selection of OTC drugs Poor drug hx Sensory and mental deficits Drug induced confusion Lack of knowledge drugs/effects/aging ```

Question 36

Causes of drug toxicity in older adults - pharmacy causes

Answer 36

Automatic refills Error No medication/interaction profile

Question 37

Guidelines for safety with medications for older adults

Answer 37

Make sure they know the meds they are on Make sure they are taking prescribed amount Refer on if you or pt recognizes side effects Encourage pt to see pharmacist to review meds

Question 38

Causes for lack of compliance

Answer 38

``` Inability to afford Inability to adhere to complicated regimen Cognitive, funct, sens impairment Lack of knowldege Denial of illness Unclear instructions Inappropriate dosage form Feel better without med Use of alcohol ```

Question 39

Compliance aids

Answer 39

``` Calendars Charts Blister packs Pill boxes Programmable alarm devices Caregiver training Home health aides ```