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Session 4 Pharm- 9
Pharm -9- Geri Pharm
| Question | Answer |
|---|---|
| If I am talking about what the body does to the drug like absorption, distribution, metabolism and clearance what am I likely talking about | The pharmacokinetics of the drug |
| If I am talking about what the drug does to the body ie affecting trasmitters, receptors, second messengers then what am I talking about | Pharmacodynamics of the drug |
| What areas of pharmacokinetics are changed with aging | all of them affects absorption, distribution, metabolism, clearance/elimination |
| T/F absorption of drugs is greately affected by aging | F no significant change with age gut affected by achlorhydria, prolonged transit time in gut and other drug interactions |
| Why is distribution affected with aging | decreased water and lean muscle mass decreases distribution of hydrophilic drugs and increased fat % increases distribution of lipophilic drugs. THere can also be a change in the levels of transport proteins with age |
| T/F acetylation of drugs does not change with aging | T |
| T/F oxidative metabolism by cytochrome -450 declines with aging decreasing ability to clear drugs | T |
| T/F aging is the single greatest predictor alone of metabolism of drugs declining in the liver | F- aging does play a role but is genetics, nutrition, environmental exposure and disease have a greater effect than aging alone |
| What are the metabolic characteristics of the ideal drug for an elderly pt | undergoes phase II metabolism and does not compete for, induce or suppress its own metabolism |
| T/F serum creatinine tends to not change with aging showing that pts can eliminate drugs through the kidney just as easily in aging | F serum creatinine tends not to change but remember you have decreased lean body mass creatinine levels remaining the same is falsely reassuring |
| What equation can you use to check kidney function and creatinine clearance | Cockcroft-Gault Formula (ages 40-80) |
| What type of drugs are eliminated via the lungs | volatile drugs |
| Why are volatile drugs avoided in the elderly | they generally have decreased lung function and more likely to have active pulmonary disease which would reduce elimination of volatile drugs via the lungs |
| Why is it hard to establish pharmacodynamic changes in the elderly | difficult to account for baseline differences, cultural and educational differences that can affect subject responses to a drug |
| Why do you see a pharmacodynamic shift in the CNS active drugs in the elderly | altered neurotrasmitters/receptors, hormonal changes, impaired cerebral glucose metabolism, decreased oxygen and cerebrovascular changes, better CNS penetration with age (reduced glycoprotein activity |
| Elderly pts often have reduced P-glycoprotein activity that results in what regarding pharmacodynamics | increased CNS penetration of drugs |
| What is the EC50 | serum conenctration at which 50% of patients demonstarte an effect of a drug such as sedation |
| What happens to the EC50 of benzos in the elderly | it is decreased by 50% in older adults IE it takes 50% lower concentration to have half of elderly pts to have s/e |
| What is the likely reason that EC50 is decreased in the elderly with benzodiazepine | distribution to brain is increased in elderly adults probably from increased brain penetration of drug |
| T/F neuromuscular blocker need dose adjustment in the elderly due to increased sensitivity to the drug | F sensitivity does not change but pharmacokinetics do |
| T/F opioids have both a change in sensitivity and kinetics in the elderly | T |
| T/F the elderly are more sensitive to anesthetics | T |
| T/F there is really no change in ACE-inhibitor pharmacodynamics with age | T |
| What pharmacodynamic changes are seen in dihydrophyridines | greater response in naïve elderly |
| What changes are seen in the cardiovascualr drugs that are non dihydropyridines in the elderly | Decreased sensitivity of PR response and enhanced HR and BP responses |
| How does Beta Adrenergics change in the elderly | Beta sensitiviy decreases with age, with the exception of Beta blockers in elderly with very high blood pressure |
| Pts Creatinie Clerance is less than 30ml/min what would not be a good choice as a diuretics | Hydrochlorothiazide |
| The change in response to diuretics by the elderly is largerly due to pharmacodynamic changes | F most due to pharmacokinetic changes |
| What is one of the greatest predicotrs of anticoagulant response | Age |
| If pt receives either an inappropriate drug or the wrong dose what has just occurred | a drug error |
| what is an adverse drug event | any drug related incident that results in harm to the patient |
| What are some common causes of serotonin syndrome (general causes not specific drugs) | Too high a dose of meds, combining meds with similar effect on serotonin levels, some illicite drugs and herbal supplements can cause serotonin syndrome |
| What are the s/sx of serotonin syndrome | Agitation, confusion, tachycardia, HA, diaphoresis and diarrhea |
| T/F opiates and opiate like drugs can cause serotonin syndrome | T |
| T/F antiepileptics can cause serotonin syndrome | T especially when combined with valproic acid |
| If pt has new pain symptoms and they are taking an antidepressant what caution should you exercise | if you give an opiate go low and go slow until pain is managed |
| What is the tx for serotonin syndrome | stop meds, hydrate pt, cool to counteract hyperpyrexia, benzos for agitation but best to prevent it |
| Which develops more rapidly serotonin syndrome or neuroleptic malginant syndrome | Serotonin syndrome develops minutes to hours while NMS takes days to week |
| What are the s/sx of neuroleptic malignant syndrome | muscle rigidity (lead Pipe), autonomic dysregulation, hyperthermia and altered mental status (even coma) |
| What is the tx for neuroleptic malignant syndrome | stop culprit med, cool pt, support vital functions, mild benzo, moderate dopamine agonist (bromocriptine), severe dantrolene (for muscle rigidity) |
| If pt develops neuroleptic malignant syndrome what should you switch them to | switch to atypical antipsychos |
| What is the difference between Serotonin Syndrome and Nueroleptic Malignant syndrome in medication cause | Serotonin= Serotonergic drug NMS=dopamine agonist |
| What is the difference between Serotonin Syndrome and Nueroleptic Malignant syndrome in pupils | Ser=mydriasis; NMS=normal |
| What is the difference between Serotonin Syndrome and Nueroleptic Malignant syndrome in bowel sounds | Ser= hyperactive; NMS=normal or decreased |
| What is the difference between Serotonin Syndrome and Nueroleptic malignant syndrome in reflexes | Ser=hyperreflexia; NMS=bradyreflexia |
| What is the difference between Serotonin Syndrome and Nueroleptic malignant syndrome in lab values | Ser will rarely have elevated aminotransferases and rhabdo while these are common findings in NMS |
| What is an adverse drug event in parkinson's disease marked by fever, rigidity, autonomic instability, and risk of aspiration pneumonia | Parkinsonism-hyperpyrexia syndrome from withdrawal/decrease of dopaminergic meds or amantadine and anticholinergics |
| What is the tx for parkinsonism-hyperpyrexia syndrome | dopaminergics, supportive care +/- methylpredisolone |
| What is the tx for parkinsonian dyskinesia | lower dose of dopaminergics, give mild benzo for dyskinesia |
| What is the tx for acute dystonic reaction | stop precipitating med give anticholinergics benzotropine or diphenhydramine |
| T/F baclofen withdrawal is not not concerning and you can stop med without tapering | False life threatening syndrome with rigidity, fever, change in menatl status, worsening dystonic symptom so taper withdrawal |
| What is the prescribing cascade | tendency to prescribe a med to address a s/sx caused by another medication usually no appreciated |
| What are the mild s/e of anticholinergics | dryness of mouth, dilation of pupils, urinary hesitancy, decreased sweating, drowsiness/fatigue, mild amnesia, inability to concentrate |
| What are the moderate s/e of anticholinergics | thirst, vision disturbances, constipation, reduced gastric secretions/emptying, increased heart rate, excitement/restlessness, confusion and memory impairment |
Created by:
smaxsmith
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