Pharmacology Considerations in Gerontology

Question 1

__________: Study of how the body interacts with drugs, including absorption, distribution, metabolism and excretion

Answer 1

Pharmacokinetics

Question 2

a. For most of the drugs taken by the elderly,
absorption is unaffected unless the patient takes the
medication with an adsorbent, such as an ______.

Answer 2

antacid

Question 3

b. Instruct patients to take antacids ___ hour before or 4 hours after other medications

Answer 3

1

Question 4

a. Distribution is unaffected unless the patient is

affected by serious ______ disease

Answer 4

cardiovascular

Question 5

b. _________ = dose/volume of distribution

Answer 5

Concentration

Question 6

Distribution

c. Free drug in ________; target site availability; tissue storage

Answer 6

circulation

Question 7

2. Distribution
   d. Fluid and tissue compartments
   • i) ______ in total body water

Answer 7

Decrease

Question 8

2. Distribution
   d. Fluid and tissue compartments
   • ii) _______ in fat

Answer 8

Increase

Question 9

2. Distribution
   d. Fluid and tissue compartments
   • • iii) _______ in muscle mass

Answer 9

Decrease

Question 10

2. Distribution
   e. Plasma drug-binding proteins
   • i) Decrease in serum _____ levels

Answer 10

albumin

Question 11

a. Metabolism may be significantly reduced in the geriatric patient, particularly if there is any _____impairment. Dosage adjustments may be necessary.

Answer 11

liver

Question 12

Metabolism:
i) Natural decrease in hepatic ___ ____; often
associated with potential decreased first pass effects

Answer 12

blood flow

Question 13

4. Elimination
   a. Renal clearance is significantly ______ in older adults. As a result, many drugs can be therapeutic at dosages lower than prescribed for a younger adult. Consider a lower dosage and consult a geriatric dosage handbook for accurate dosing in the geriatric patient.

Answer 13

reduced

Question 14

b. In the patient with renal insufficiency, drug dosages may be significantly reduced.
Renal function must be monitored to both prescribe the appropriate dose and assesses for adverse reactions. Thus, drug elimination changes in the elderly are due to overall, decreased renal function.
• i) _____ blood flow to the kidneys

Answer 14

Decreased

Question 15

b. In the patient with renal insufficiency, drug dosages may be significantly reduced.
Renal function must be monitored to both prescribe the appropriate dose and assesses for adverse reactions. Thus, drug elimination changes in the elderly are due to overall, decreased renal function.
• ii) _____ glomerular filtration

Answer 15

Decreased

Question 16

b. In the patient with renal insufficiency, drug dosages may be significantly reduced.
Renal function must be monitored to both prescribe the appropriate dose and assesses for adverse reactions. Thus, drug elimination changes in the elderly are due to overall, decreased renal function.
• iii) _______ tubular secretion

Answer 16

Decreased

Question 17

b. In the patient with renal insufficiency, drug dosages may be significantly reduced.
Renal function must be monitored to both prescribe the appropriate dose and assesses for adverse reactions. Thus, drug elimination changes in the elderly are due to overall, decreased renal function.
• iv) _____ in creatinine clearance

Answer 17

Decline

Question 18

__________: Study of how drugs interact with the body

Answer 18

Pharmacodvnamics

Question 19

Pharmacodynamics:

1. Receptor changes
   a. Receptors may up-regulate or down-regulate with age, causing an increased or decreased ____ to certain agents.

Answer 19

sensitivity

Question 20

Pharmacodynamics:

2. __________ changes
   a. Decreased capacity to respond to physiological challenges and the adverse side effects of drug therapy (e.g., orthostatic hypotension)

Answer 20

Homeostasis

Question 21

___________: Study of single-gene genetic variations in drug variations
1. The goal of pharmacogenetics is to understand the role that an individual’s genetic makeup plays in how well a medication works, including any likely side effects.

Answer 21

Pharmacogenetics

Question 22

__________:

2. Benefits
   a. Development of drugs that maximize therapeutic effects
   b. More accurate methods of determining dosages
   c. Drugs that are prescribed specifically for a patient’s genetic profile

Answer 22

Pharmacogenetics

Question 23

1. __________ begins with an unexpected drug response, and then searches for a genetic cause.

Answer 23

Pharmacogenetics

Question 24

2. __________ begins with looking for genetic differences within a population that explain certain observed responses to a drug.

Answer 24

Pharmacogenomics

Question 25

``` Adverse Reactions 1. Common adverse reactions seenin the elderly a. Central nervous system effects: • i) Sedation • ii) ____ ____ iii) Dizziness iv) Depression v) Confusion ```

Answer 25

Memory loss

Question 26

``` Adverse Reactions b. Anticholinergic effects: • i) Blurred vision • ii) Urinary retention • iii) ________ • iv) Drymouth ```

Answer 26

Constipation

Question 27

Adverse Reactions | c. Effects on ______ and balance

Answer 27

movement

Question 28

Adverse Reactions | d. Effects on _____ and supporting structures

Answer 28

bone's

Question 29

2. Drags most likely to cause adverse effects in the geriatric patient a. Those with central nervous system adverse effects • i) Benzodiazepines • • ii) ________ • • iii) Beta-blockers • • iv) Steroids v) Cimetidine vi) Narcotics vii) Diuretics

Answer 29

Antipsychotics

Question 30

2. Drags most likely to cause adverse effects in the geriatric patient b. Those with anticholinergic adverse effects • i) Cholinergic agonists • ii) ____ antidepressants • iii) Antipsychotics

Answer 30

Tricyclic

Question 31

``` Adverse Reactions: c. Those with adverse effects on balance and movement • i) Neuroleptics ii) Furosemide • iii) Metronidazole iv) ____- ____• v) Phenytoin • vi) Vasodilators • vii) Aspirin •viii) Metoclopramide • ix) Aminoglycosides ```

Answer 31

Beta-blockers

Question 32

``` Adverse Reactions: d. Those with adverse effects on bone and supporting structures • i) Steroids • ii) ______ • iii) Lithium ```

Answer 32

Heparin

Question 33

Promoting Safe Drug Use | 1. The literature evidences that non-adherence to drug regimens is noted to be approximately __% among older adults.

Answer 33

45

Question 34

Promoting Safe Drug Use 2. Recognize that patients are usually on multiple medications a. According to the Centers for Disease Control, elders with multiple diseases can easily take up to ___ different prescriptions medications every day.

Answer 34

12

Question 35

Promoting Safe Drug Use b. Geriatric patients take more ___-___ ___ drugs than any other age group.

Answer 35

over-the-counter

Question 36

Promoting Safe Drug Use 3. Recognize that self-medication may be a problem a. The patient may be using medicine that belongs to ____ ____.

Answer 36

someone else

Question 37

Promoting Safe Drug Use b. The patient may be using alternative or herbal medications or therapies that may interact _____ with prescription medicines.

Answer 37

adversely

Question 38

Promoting Safe Drug Use 4. Provide education and a _______ if a prescription drug is not indicated, as well as if one is indicated.

Answer 38

rationale

Question 39

Promoting Safe Drug Use 5. ____ ____ ___ (e.g., Mini-Mental State Examination, Geriatric Depression Screen) may be good indicators of whether a patient can manage a medication regimen.

Answer 39

Functional assessment tools

Question 40

_____ in the Elderly | 1. The use of more medicines than are clinically indicated

Answer 40

Polypharmacy

Question 41

Polypharmacy in the Elderly 2. Commonly seen in the geriatric patient due-to-several factors that promote polypharmacy a. The presence of _____ conditions

Answer 41

comorbid

Question 42

Polypharmacy in the Elderly 2. Commonly seen in the geriatric patient due-to-several factors that promote polypharmacy b. Use of multiple _____

Answer 42

prescribers

Question 43

Polypharmacy in the Elderly 2. Commonly seen in the geriatric patient due-to-several factors that promote polypharmacy c. Overuse of ____-____ and alternative medicines

Answer 43

non-prescription

Question 44

Polypharmacy in the Elderly 2. Commonly seen in the geriatric patient due-to-several factors that promote polypharmacy d. Prevalence of the concept of a "____ ____ every ill"

Answer 44

pill for

Question 45

Polypharmacy in the Elderly 3. Prevention of polypharmacy a. Recognition of the problem • i) Clinical consult with a ______ may be helpful

Answer 45

pharmacist

Question 46

Polypharmacy in the Elderly 3. Prevention of polypharmacy a. Recognition of the problem • ii) "____ _____" approach, where all medications the patient Is currently taking are brought in is useful

Answer 46

Brown bag

Question 47

``` Polypharmacy in the Elderly 3. Prevention of polypharmacy b. Education of the patient • i) Include discussion of all over-the-counter and _____ medications ```

Answer 47

herbal

Question 48

Polypharmacy in the Elderly 3. Prevention of polypharmacy c. Communication between pharmacists and prescribers is key i) "______ medicines only approach

Answer 48

Essential

Question 49

Polypharmacy in the Elderly 3. Prevention of polypharmacy d. Avoid ______ products

Answer 49

combination

Question 50

Polypharmacy in the Elderly 3. Prevention of polypharmacy e. Start with ______ effective doses

Answer 50

lowest

Question 51

4. Risks associated with polypharmacy a. Increased: • i) Morbidity • ii) Medical expense • iii) Adverse reactions • iv) Incidence of ________• v) Risk of nursing home placement

Answer 51

depression

Question 52

5. Over-the-counter agents that complicate polypharmacy a. _______: Inhibits cytochrome P450 in the liver, prolonging the effects of other drugs in the body

Answer 52

Cimetidine

Question 53

5. Over-the-counter agents that complicate polypharmacy b. ________: Antagonize the activity of antihypertensives; are anticholinergic

Answer 53

Decongestants

Question 54

5. Over-the-counter agents that complicate polypharmacy c. ____ ____ ____ ____ ___: Decrease renal blood flow, further reducing elimination of many drugs

Answer 54

Non-steroidal anti-inflammatory drugs (NSAIDs)

Question 55

5. Over-the-counter agents that complicate polypharmacy | d. _____: May exacerbate the effect of antihypertensives

Answer 55

Niacin

Question 56

5. Over-the-counter agents that complicate polypharmacy | e. ______: May adsorb other oral agents, reducing their absorbance across the gut wall

Answer 56

Antacids

Question 57

5. Over-the-counter agents that complicate polypharmacy f. Laxatives: • i) May ____ other drugs so they cannot be absorbed

Answer 57

chelate

Question 58

5. Over-the-counter agents that complicate polypharmacy f. Laxatives: • ii) May ______ gut motility•

Answer 58

increase

Question 59

5. Over-the-counter agents that complicate polypharmacy f. Laxatives: • iii) May reduce ______ of some drugs.

Answer 59

absorbance

Question 60

5. Over-the-counter agents that complicate polypharmacy g. Calcium products: • i) May _______ absorbance of thyroid hormones

Answer 60

decrease

Question 61

5. Over-the-counter agents that complicate polypharmacy g. Calcium products: • ii) T________

Answer 61

tetracycline

Question 62

6. _______ agents that complicate polypharmacy

Answer 62

Herbal

Question 63

Comorbidity influences of medication use 1. Renal disease a. In the healthy adult, renal function may be reduced as much as ___% by the elder years.

Answer 63

40%

Question 64

Comorbidity influences of medication use 1. Renal disease b. Renal disease would further impact this, affecting drug _______.

Answer 64

elimination

Question 65

Comorbidity influences of medication use 1. Renal disease c. Dosage adjustments should be made usually based on ______ clearance.

Answer 65

creatinine

Question 66

Comorbidity influences of medication use 2. Hepatic disease a. ______, cirrhosis, or liver impairment affects hepatic metabolism of most drugs.

Answer 66

Hepatitis

Question 67

Comorbidity influences of medication use 2. Hepatic disease b. As a result, serum levels of drugs may be _____, and dosages need to be adjusted accordingly.

Answer 67

higher

Question 68

Comorbidity influences of medication use 3. Cardiac disease a. Heart failure may affect perfusion of tissues and ____ _____, leading to less than optimal therapeutic outcomes.

Answer 68

drag delivery