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704 Geriatrics > PKPD > Flashcards

PKPD Flashcards

1
Q

What might cause a delay in onset of effect of drugs (analgesics, hypnotics) in older patients?

A

Delayed rate of absorption

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2
Q

Older patients have (increased/decreased) acid production

A

Decreased

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3
Q

Decreased gastric acid secretion may be normal in older patients, but what might we be still worried is causing it?

A

Atrophic gastritis (H. Pylori)

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4
Q

What comorbidity might cause decreased gastric blood flow?

A

HF

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5
Q

Which drugs are high-extraction drugs?

A
  • Propranolol
  • MSO4
  • Lidocaine
  • Verapamil
  • Labetalol
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6
Q

We need (higher/lower) doses of high-extraction drugs in older patients

A

LOWER

Reduce 1st pass effect leads to higher concentrations

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7
Q

T/F: Evidence shows a reduced bowel CYP3A4 and Pg-P activity

A

FALSE
no proven effect

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8
Q

T/F: There is not a significant effect on rate or extent of oral drug absorption in older patients due to aging

A

TRUE

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9
Q

Why do older patients have decreased absorption of topical lipophilic compounds?

A

Their skin is dryer, less perfused, and more fatty

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10
Q

What is the condition to be concerned with when using fentanyl patches?

A

Cachexia (decreased effect)

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11
Q

What ointments/creams can have decreased absorption in older patients?

A

Steroids, hormones

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12
Q

T/F: Drugs taken via the sublingual, buccal, and rectal routes will have impaired absorption in older patients

A

FALSE
mostly the same

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13
Q

What effect does decreased body mass have on digoxin?

A

Higher concentrations
Less mass (Vd) to distribute into causes higher concentrations

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14
Q

What effect does increased fat percentage have on benzodiazepines?

A

Longer t1/2
Higher Vd of lipophilic drugs

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15
Q

What effect does lower body water have on hydrophilic drugs?

A

Higher concentrations
Lower Vd

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16
Q

T/F: Albumin levels are generally the same between older and younger patients

A

TRUE
albumin drops might alert us to severe, chronic, or underlying illnesses

17
Q

When is a1-acid glycoprotein (AAG) elevated?

A

Acute illness, infection, CA, inflammation

18
Q

What considerations with AAG do we have for drugs?

A

High affinity for basic drugs (decreased concentrations with high AAG levels)

19
Q

How does hepatic CYP3A4 activity change with aging?

A

Decreases

20
Q

How does hepatic CYP2D6 activity change with aging?

A

Not affected by aging

21
Q

T/F: Phase II metabolism (glucuronidation/acetylation) is generally unchanged with aging

A

TRUE

22
Q

What phase II process might be reduced in patients >80 years?

A

Glucuronidation

23
Q

T/F: There is an independent decrease in hepatic blood flow with age

A

FALSE: no clear evidence, may be due to lowered cardiac output

24
Q

What classes of drugs may not be metabolized well in older patients?

A
  • Benzodiazepines
  • CCBs
  • NSAIDs
25
Q

What types of metabolizers might be at higher risk of ADEs with aging?

A

Slow metabolizers

26
Q

Inhibition of metabolism generally (increases/decreases/stays the same) with age

A

Stays the same

27
Q

How does kidney mass change with age?

A

Reduces up to 25% from ages 40-90

28
Q

How does renal blood flow change with age?

A

Reduces 10% per decade
Exceeds reduction in cardiac output

29
Q

How does glomerular function change with age?

A

Biphasic decline
Gradual until age 40, rapid afterwards

30
Q

Should you round or adjust for low SCr when calculating CrCl?

A

NO!!!

31
Q

Which drugs should we be worried about with impaired renal function?

A
  • Hydrophilic beta blockers (atenolol, bisoprolol)
  • ACEi
  • Fluoroquinolones
  • Vancomycin, aminoglycosides
32
Q

T/F: There are no real generalizations for pharmacodynamics in aging

A

TRUE

704 Geriatrics (8 decks)

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