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DU PA Pharm Geri

Duke PA Pharmacology Geriatrics

factors that affect the absorption of drugs in the elderly decreased GI motility, decreased GI blood flow, increased gastric pH
if GI motility is decreased but GI blood flow is decreased how is absorption affected in the elderly absorption time is increased therefore drug absorption is quantitatively unaffected
change in body composistion as we age decrease in lean body mass, increase in adipose tissue
fat soluble drugs' volume of distribution __ with age increases
water solubel drugs' volume of distribution __ with age decreases
with drugs that bind to albumin a decrease in total body water and a decrease in albumin lead to an increase in __ free drug
__ blood flow decreases with age affecting the speed at which drugs are metabolised hepatic
which phase of drug metabolism decreases little with age phase II (conjugation reactions)-acetylation, sulfonation, glucoronidation
MS is a 76 year old male who tried behavioral modifications, but he still has anxiety and difficulties sleeping at night. Which benzodiazepine is the most appropriate? temazepam
ZD is a 75 year old female who recently started taking Naproxen 200mg every 8 hours OTC. What might concern you regarding this elderly patient? decreased GI motility
decrease in renal blood flow, renal function affects __ of drug and may result in accumulation elimination
common drugs with renal impairment recommendations allopurinol, aminoglycosides, nitrofurantoin, cephalosporins, digoxin, hydrochlorothiazide, vancomycin, amantadine, ranitidine, lithium, NSAIDs, insulin, metformin, sulfamethoxole/trimethoprim
if renal clearance is less than __ then hydrochlorothiazide is not as effective 30
lean body mass decreases with age so as we age __ may not adequately reflect renal function serum creatinine
measuring serum creatinine in an elderly patient may lead to what assumption overestimation of renal function b/c of reduced muscle mass
elderly have an increased sensitivity to __ narcotics, benzodiazepines, anticoagulants
elderly have a decreased sensitivity to __ beta-adrenergic blockers
elderly have a decreased __receptor function baro
any symptom in an elderly person should be considered a __ until proven otherwise drug side effect
highly protein bound drugs phenytoin, warfarin
narrow therapeutic index drugs digoxin, phenytoin, warfarin, carbamazepine, theophylline, levothyroxine, cyclosporine, lithium, procainamide, ethosuximide
grapefruit interacts with statins (atorv/lov/simv), calcium channel blockers (diltiazem,felodipine,nicardipine,verapamil), amiodarone, cilostazol, losartan
drug disease interaction with dementia and anticholinergics, opiates, psychotropics
in a patient with BPH __ can cause obstructive urinary symptoms anticholinergics
postural hypotension is exacerbated by diuretics, antihypertensives, antidepressants, levodopa
ways to improve adherence to medication regimen pillboxes, simplify regimens, med counseling, associate with part of daily routine, identify barriers
potential barriers to patient adherence to medication regimen cost, visual impairment, dexterity, literacy/understanding
discontinue meds with __ to combat polypharmacy no benefit/no indication
do not treat __ with another medication an ADE
indicated post MI aspirin, beta blockers
aspirin is indicated in which situations post MI, CAD, TIA, angina, PVD, stroke prevention
meds indicated for hypertension beta blockers, ACE inhibitors
meds indicated in heart failure ACE inhibitor, spironolactone
meds indicated in hypercholesterolemia statins
meds indicated in atrial fibrillation warfarin
what is the Beers criteria used to address inappropriate medication use in the older adult
characteristics of osteoporosis low bone mass, deterioration of bone tissue and disruption of bone architecture, comprimised bone strength, and an increase in the risk of fracture
peak bone mass by age __ 25-30
removal of older bone, replaced with new bone bone remodeling
function of osteoclasts breakdown old bone (clasts-crunch)
function of osteoblasts build new bone (blasts-build)
BMD T score of -1 and above normal bone
BMD T score of -1 and 2.5 osteopenia
BMD T score of -2.5 and below osteoporosis
risk factors for osteoporosis low calcium, high caffeine, alcohol, smoking, vit D insufficiency, high salt intake, low activity, falling, excess vit A, aluminum, thinness
medications that are risk factors for osteoporosis heparin, anticonvulsants, cyclosporine A and tacrolimus, gonadotropin releasing hormone agonists, barbituates, lithium, depo-medroxy-progesterone, chemo, glucocorticoids
BMD testing for women >__ yo 65
BMD testing for men >__ yo 70
BMD testing for women or men at __ with risk factors for osteoporosis 50-69
universal recommendations to protect bone mass adequate intake of calcium and vitamin D
adverse effects of calcium constipation, bloating, cramps, flatulance, reduced absorption of meds (levothyroxine, iron, tetracycline, fluoroquinolones)
who doe we treat for for osteoporosis? postmenopausal women and men age 50 and up with__ hip/vertebral fx, hip/femoral neck or spine T-score < or = -2.5, low bone mass and a US-adapted 10 yr probability of a hip fx >3% or of any major osteoporosis related fx
approved treatments for osteoporosis bisphosphonates, calcitonin, estrogens/hormone therapy, estrogen agonist/antagonist, parathyroid hormone
FDA approved bisphosphonates alendronate (fosamax), ibandronate (boniva), risedronate (actonel), zoledronic acid (reclast)
bisphosphonate MOA decrease bone resorption by binding to the bone matrix and inhibiting osteoclast activity. remains in bone for a long period of time
bisphosphonate administration (alendronate and risedronate) take after an overnight fast, with 8 oz plain water, sit or stand for 30 min, do not take with other meds or fluids, do not chew or suck the tablet
ibandronate administration take after an overnight fast, with 8 oz plain water, sit or stand for 1 hr, do not take with other meds or fluids, do not chew or suck the tablet, do not eat for 1 hour
administration of zolendronic acid intravenous infusion over 15 minutes once yearly
AE's of bisphosphonates GI (difficulty swallowing, inflammation of esophagus, gastric ulcer), ab pain, nausea, dyspepsia, osteonecrosis of jaw (rare)
calcitonin MOA reduces # of osteoclasts and prevents resorptive activity. temporarily improves bone formation by increasing osteoblastic activity
calcitonin AE's dermatologic (flushin, edema at inj site), GI (nausea, diarrhea), musculoskeletal (back/joint pain), respiratory (rhinitis, nasal irritation)
estrogen reduces the risk of vertebral fx, hip fx, osteoporotic fx
estrogen increases the risk of MI, stroke, invasive breast cancer, PE/DVP
estrogen agonist/antagonist MOA selective estrogen receptor modulator, estrogen agonist in bone, decreases bone resorption and bone turnover, increases bone mineral density
serious estrogen agonist/antagonist AE's DVT, PE, stroke, MI
parathyroid hormone MOA when given once daily preferential stimulation of osteoblastic activity over osteoclastic activity
parathyroid hormone AE Cardiovascular (hypotension, syncope), Derm (rash, sweating), Endocrine (hyperuricermia), GI (constipation, diarrhea, indigestion, N/V), Musculoskeletal (arthralgia/spasm), Neurologic (asthenia, dizziness), resp (cough, pharyngitis, rhinitis)
medications that may induce dementia/delerium psychotropics, sedatives, hypnotics, cardiac antiarrhythmics, meds with anticholinergic properties
medications with anticholinergic properties oxybutynin, diphenhydramine, tolterodine, amitriptyline, doxepin, benztropine
with alzheimer's disease there are no treatments that __ reverse the disease, stop the disease
goals of alzheimer's treatment preserve cognitive and functional ability, minimize behavioral disturbances, slow the progression of the disease
pharmacological therapies for alzheimer's disease cholinesterase inhibitors, NMDA antagonists
cholinesterase inhibitors used for treatment of alzheimer's tacrine (Cognex), donepezil (Aricept), rivastigmine (Exelon), galantamine (Razadyne)
cholinesterase inhibitors MOA results in __ an increase of acetylcholine available for synaptic transmission in the CNS
donepezil has a __ half life long- 70 hours
rivastigmine has a __ half life very short - 1 hour
Donepezil is used for __ Alzheimer's mild, moderat, and severe
galantamine has a __ half life short - 7-8 hours
memantine has a __ half life long 60-100 hours
memantine is used for __ Alzheimer's moderate to severe
vitamin E with alzheimer's/dementia no benefit with mild cognitive impairment
elderly patients with dementia related psychosis treated with antipsychotic drugs are at an increased risk of __ death
Created by: bwyche