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DU PA Pharm Geri
Duke PA Pharmacology Geriatrics
| Question | Answer |
|---|---|
| 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
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