Exam #2: Geriatric Pharmacotherapy Flashcards Preview

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Flashcards in Exam #2: Geriatric Pharmacotherapy Deck (27)
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1
Q

What is the BEERS list?

A

List of drugs that should NOT be used in the geriatric population

2
Q

How do you want to dose medications in geriatric patients?

A

Start low and then slowly work up

3
Q

How does bioavaliablity of drugs change in the geriatric population?

A
  • Bioavaliablity is NOT changed

- Peak serum concentrations may be lower & slower

4
Q

What is the big exception to drug bioavaliablity in the elderly?

A

Drugs with extensive first-pass metabolism may have HIGHER serum concentrations due to decreased liver function w/ age

5
Q

What are the factors that affect drug absorption?

A
  • Route
  • What its taken w/
  • Comorbid illnesses

**Grapefruit juice

6
Q

How can gastric pH alter absorption of durgs?

A

Increased gastric pH may increase or decrease absorption of some drugs

E.g. proton pump inhibitors will RAISE gastric pH

7
Q

How is metabolic clearance altered in the elderly? Why?

A

Metabolic clearance is reduce b/c:
- decreased liver blood flow, size, and mass

*****Liver is the most common site of drug metabolism

8
Q

What questions should you be asking your elderly patients in regards to metabolic clearance?

A

1) Any liver problems

2) Alcohol use

9
Q

Aside from liver issues, what are other factors that affect drug metabolism?

A
  • Age & gender
  • Hepatic congestion from CHF
  • Smoking

*****Note that blood-thinning medications are most associated with CHF

10
Q

What is the most common arrhythmia in the elderly?

A

A-fib

11
Q

Why is a-fib common in the elderly?

A

Uncontrolled HTN leads to remodeling of the heart & predisposition to a-fib

12
Q

What is the definition of half-life?

A

Time to get to 1/2 the serum concentration of a drug

13
Q

What is clearance?

A

Volume of serum from which the drug is removed per unit time

14
Q

What is a common initial presentation of anaphylaxis in the elderly?

A

Nausea & vomiting

15
Q

Where do most drugs exit the body?

A

Kidney

16
Q

What does reduced drug elimination by the kidneys result in?

A

Drug accumulation & toxicity

17
Q

What is the overall result of aging on the kidneys? What are the specific effects of aging on the kidneys?

A

Decreased GFR

  • Decreased size
  • Decreased RBF
  • Decreased number of functioning nephrons
  • Decreased renal tubular secretion
18
Q

Why does creatinine stay in the normal range in the elderly, even though there is decreased creatinine clearnace?

A

Decreased lean body mass= lower creatinine production

BUT

Decreased GFR= compensation & roughly normal creatinine levels

19
Q

What is the problem with benzodiazepines in geriatrics?

A

More sedation & poorer psychomotr performance

20
Q

When you get to a new hospital or region, what should you find out about drugs?

A

What meds are prescribed in that region for common conditions

21
Q

What medications are most commonly associated with ADEs?

A
  • Cardiovascular
  • Diuretics
  • NSAIDs
  • Hypoglycemics
  • Anticoagulants

**NSAIDs potentially the worst

22
Q

What food can exacerbate CHF?

A

BBQ (high salt)

23
Q

What has been the most effective way to prevent renal failure associated with DM?

A

ACE inhibitors

24
Q

What is the most common side effect of an ACE inhibitor?

A

Cough

25
Q

What are beta-blockers best used for in the geriatric population?

A

Post MI or CHF

26
Q

Before adding a drug, what must you consider?

A

Am I prescribing a drug to treat a new symptom or to treat a side effect of a previously prescribed drug?

27
Q

What is the most common side effect of a drug?

A

GI disruption