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35 Cards in this Set
- Front
- Back
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Are older person more or less sensitive to beta-blockers? Why?
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more sensitive. Elderly can't get their HRs up as quickly as the young
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Is there an increase or decrease in circulating catecholamines in the elderly?
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Increase
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Common side effect among elderly with sedative
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delirium
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How many drugs is the average inpatient receiving?
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6-10
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dose-dependent toxicities
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too much opioids (respiratory depression), digoxin (arrhythmia)
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non dose-dependent toxicities
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allergic reactions, bone marrow suppression
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How are most drugs metabolized?
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by cytochrome p450
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which cytochrome is very polymorphic?
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CYP206
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thiopurine methyltransferase
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very, very polymorphic
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What % of whites are poor metabolizers?
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6% (codeine)
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Which 3 drugs recommend genetic testing by the FDA?
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thiopurine methyltransferase (metabolizes 6-mercaptopurine, 6-thioguanine, and azathioprine); abacavir; carbamazepine
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Why measure for thiopurine methyltransferase in treating leukemic patients?
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at high doses, pt. will have toxic response if deficient in this enzyme
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Why genotype testing for abacavir?
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antiretroviral. 50% of carriers of certain genotype will have allergic rxn. - 2.7% of population
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In what population do you do genetic testing for carbamazepine?
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Asians. increased incidence of Steven-Johnson's syndrome
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AEs of morphine
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respiratory depression (elevated pCO2), histamine release, contraction of sphincter of Oddi (elevated blood amylase levels), vasodilation
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Juice that inhibits P450s in GI tract
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grapefruit juice
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What agents inhibit dihydrofolate reductase?
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methotrexate, trimethoprim, pyrimethamine
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What happens when treated with cephalosporins?
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decrease synthesis of vitamin K, may increase effect of warfarin
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What does nitrous oxide destroy?
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vitamin B12
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What causes the excretion of vitamin B6
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isoniazid
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Inhibits absorption of vitamin D and can cause vitamin D deficiency
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phenytoin
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What causes incorrect measurement of drug in blood?
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another drug that displaces first drug from serum albumin
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What precipitates in dextrose?
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phenytoin
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what precipitates in saline?
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amphotericin
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Aminoglycosides form complexes with what in solution?
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beta-lactams
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Divalent and trivalent cations (calcium, magnesium, aluminum) will decrease absorption of what?
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quinolones, tetracyclines, azithromycin
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What's necessary for absorption of ketoconzazole?
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acidic environment in stomach, so no H2 antagonists or pump inhibitors!
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What decreases absorption of ciprofloxacin?
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antacid
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Why give saquinavir (for HIV) and ritonavir together?
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Ritonavir is a P450 inhibitor so get therapeutic effect of saquinavir
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Anti-coagulants are a major cause of what?
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drug-drug interactions!
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What drugs induce cytochrome P450?
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rifampin, barbiturates, carbamazepine, phenytoin, anti-epileptic drugs, St. John's Wort, alcohol
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What happens if someone is taking acids?
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they will acidify their urine and enhance the excretion of alkaline drugs
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Two major toxicities of NSAIDS?
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GI tract and kidney (inhibit prostaglandin synthesis which is important in blood flow). Causes K+ retention.
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present with HTN, tachy, tachypnea, hyperthermia
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neuroleptic malignant syndrome, malignant hyperthermia, serotonin syndrome
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What drugs should one not use in elderly?
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1st generation anti-histaminics, anti-spasmodics, typical antipsychotics (all have anti-cholinergic effects)
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