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Flashcards in Polypharm overview Deck (26):
1

decreases in asbsorption with age

decreased small bowel surface area
slowed gastric empything
increased gastric pH

2

rates of drug metabolism have what type variability

person to person

3

drugs with what conjugation don't have an affected clearance

glucuronic acid

4

what kidney test should be used to evaluate kidney function

BUN

5

if a patient is taing a benzo what should you make sure they aren't taking?

kava

6

what may valerin affect?

sedatives

7

Decrease in distribution reasons

Decrease in lean body mass (muscle) & increase in total body fat
Decrease in total body water
Decrease in serum albumin

8

Changes in metabolism with age

Liver mass & hepatic blood flow decrease
Decreased first pass metabolism
Rates of drug metabolism have person-to-person variability
Multistage metabolic clearance likely more prolonged
Drugs w/glucuronic acid conjugation - clearance not affected

9

Changes in elimination with age

Age related decrease creatinine clearance varies person-to-person
Dynamics renal vs. systemic clearance & drug’s maximum tolerated dose vs. minimum effective dose

10

What are 3 drugs that old people are on in nursing home?

atypical antipsychotics
warfarin
sedative-hypnotics

11

What are 3 drugs that old people are on in community dwelling?

Anti-DM
NSAIDs
Benzodiapines

12

May - intensify/prolong sedatives; reduce iron absorption, increase bleeding risk/warfarin d/t phytocoumarins

Chamomile

13

May – potentiate drugs /cytochrome P-450 (amiodarone, methotrexate)/monitor LFTs

Echinacea

14

May – additive vaso-constrictive effects; inhibit platelet aggregation/additive effect, reduce iron absorption, additive effect/warfarin

Feverfew

15

May – inhibit platelet aggregation & fibrinolytic effect, augment Warfarin’s effect, augment anti-HTN meds

Garlic

16

May - inhibit platelet aggregation, augment Warfarin’s effect

Ginger

17

May – decrease efficacy anticonvulsants d/t contaminants, augment inhibition platelet aggregation/NSAIDS, augment Warfarin’s effect

Gingko

18

May – intensify anti-DM agents (glipizide), augment ASA/platelet aggregation inhibition, intensify steroid effects d/t anti-inflammatory properties, increase digoxin levels, reduce effectiveness opioids, augment Warfarin effects

Ginseng

19

Augment effects sedatives (benzodiazepines)

Kava

20

May – reduce effect/digoxin, reduce iron absorption, increase photosensitivity, augment SSRIs, TCAs, reduce Warfarin level

St. John's Wort

21

Augment effects sedatives

Valerian

22

______ is least affected by age

Absorption

23

What are 3 non age related effects on excretion that should also be considered in elderly?

hydration
CO
intrinsic renal disease

24

Pharmacodynamic Changes

Age-related changes in tissue sensitivity that affect responsiveness to drug concentrations

25

What is the confusion assessment method?

Used to screen for delirium
Administered in <5 minutes
Does not assess severity or cause

26

What are the 4 features of CAM that are found to have greatest ability to distinguish delirium from other types of cognitive impairment?

Acute Onset
Inattention
Disorganized thinking
Altered LOC

Diagnosis of delirium needs 1 and 2 with either 3 or 4