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20 Cards in this Set
- Front
- Back
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what happens to elderly absorption wrt the stomach?
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increased pH, Decreased GI blood flow
NOTE: dec blood flow = dec fursemide abs also change in motility-emptying rate |
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What happens to elderly first pass extraction?
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Variable on high clearance drugs
inc bioavail: labetolol, verapamil, nifedipine, lidocaine no change: morphine, metoprolol, amitriptyline |
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What happens to actively transported medication from the small bowel?
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Decreased abs of vit b12, calcium, and iron
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what happens to p-glycoprotein in the elderly?
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decreased p-glycoprotein
possibly higher drugs and toxin levels |
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Elderly changes in body composition?
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increase in body fat
dec lean body mass decrease in body water |
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effect of elderly changes in body composition? (1 of 2)
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increase in Vd of lipid soluble drugs (diazepam) aka inc t1/2
dec Vd for water soluble drugs (ethanol, lithium digoxin) = inc Cp |
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effect of elderly changes in body composition? (2 of 2)
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dec plasma albumin levels
unchanged or 15-20% decline effect increased free drug fraction (phenytoin, valproic acid) |
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aging alpha 1 glycoprotein?
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increases during age and acute illness
binds to lipophilic basic drugs effectively decreases lidocaine and propranolol |
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elderly intragastric metabolism and levodopa?
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reduction in gastric wall content of dopa-decarboxylase w/age
effect: 3x increase in levadopa |
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what happens to liver size and products?
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decrease in size, dec blood flow to liver
no change in bilirubin, alkaline phosphatase, or cholesterol albumin can stay the same or dec |
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What happens with phase 1 metabolism in the elderly?
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decreased due to less O2 in the liver
effect: dec clearance of drugs using phase 1 |
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drugs with dec liver metabolism due to dec phase 1 HYDROXYLATION reactions?
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Alprazolam
Barbiturates Carbamazepine Ibuprofen Phenytoin Warfarin |
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drugs with dec liver metabolism due to dec phase 1 REDUCTION reactions?
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diazepam
chlordiazepoxide diphenhydramine meperdine |
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drugs with dec liver metabolism due to dec phase 1 AKYLATION reactions?
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dcdm+
amitriptyline lidocaine theophylline |
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What is the change in elderly phase II reactions?
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no change...
conjugation acetylation methylation (APAP) |
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Renal elimination in elderly?
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decrease in...
GFR renal plasma flow tubular function reabs capacity weight loss of 30% Glomeruli up to 60% loss!!! |
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What happens to the estimation of GFR?
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CrCl overestimates GFR
still a useful tool |
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what about NSAIDS w/GFR in elderly?
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NSAIDS dec prostaglandins which dec flow of blood to kidneys
diuretics also effect GFR HOW??? |
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what can cause poor perfusion of the kidneys?
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CHF or anesthesia
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pharmacodyamic changes in the elderly brain?
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decreased density of ach receptors
Mu receptors: more sensitive at high pain sigma: down reg causes anxiety and aggravated/depressive behaviors |
