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137 Cards in this Set

  • Front
  • Back
Noncompliance ranges from __ to __%
21, 55
Most common adverse drug events due to?
- NSAIDs
- Cardiovascular
- Psychotropic
T/F - Drug absorption is decreased with age.
False - little effect with age
T/F - Most drug absorption is active.
False - passive, dependent on drug conc
T/F - Active drug absorption less absorbed in older adults.
True
What drugs/supplements are less actively absorbed?
Calcium, organic calcium, certain vitamins (i.e. Vitamin D)
Distribution of drugs in the body is dependent on...
body composition, plasma protein binding, blood flow to organs
T/F - Age leads to less water and fat.
True
(Fat/Water) soluble drugs have incr distribution, and (fat/water) soluble drugs are distributed less.
Fat, water
Barbituates (phenobarbital) and benzodiazapines (diazepam) are (fat/water) soluble drugs.
Fat
Ethanol, digoxin, and cimetidine are (fat/water) soluble drugs
water
T/F - Pharmaceutically active drugs are not bound to albumin
True
Age reduces albumin by __%. What is the significance of this?
25%; more drug in system, thus intense clinical effect and greater risk of adverse effects
The reduction of albumin with age is significant in which drugs mentioned?
Warfarin, phenytoin
T/F - Hepatic blood flow decreases w/ age.
True
T/F - Smoking does not affect the metabolism of drugs.
False - affects metabolism
T/F - Drugs do not break down as fast and stay in the body longer in the elderly.
True
How does drug elimination relate to the kidneys in the elderly?
Decr renal blood flow and GFR so decr drug elimination
What is the significance of creatinine? Does it decr, remain stable, or incr w/ age?
Meas renal drug elimination. Decr.
Monitor creatinine in pts taking these drugs...
Digoxin, Chlorpropamide, Cimetidine, Lithium
What effect does cigarette smoking have on metabolism?
Induces hepatic microsomal enzyme activity but effect on drug metabolism is variable.
The majority of hospital admissions in elderly is due to what type of disease?
Cardiovascular
T/F - HTN, especially diastolic pressure increases after age 50.
False - systolic
What impact does thiazide diuretics show on pts with renal impairment?
Decreased natriuretic effect, esp when creatinine clearance below 20 ml/min - may lead to decr cardiac output and electrolyte imbalance
What drug class incr risk of hypokalemia?
Diuretics (thiazide diuretics?)
Diuretic vision effects?
Sudden onset myopia or changes in refraction
Digoxin (cardiac glycoside) half life elimination is (incr/decr) in older adults?
incr
What cardiovascular drug class has a narrow dosage level difference between therapeutic and toxic levels?
cardiac glycosides e.g. digoxin
What drugs enhances digoxin effects?
Diuretics and certain Ca-channel blockers e.g. verapamil
Cardiac glycosides can cause what kinds of side effects?
GI, cardiac, neuro, and visual disturbances (altered color vision - greens)

Toxicity = nausea, anorexia, fatigue, depression
T/F - Beta blockers are effective heart meds for the elderly.
False - decreased clinical response due to reduced interaction w/ cell receptors; also higher side effects (depression, confusion, incr falls)
Pts taking Ca-channel blockers and ACE inhibitors must be monitored for dosage and freq if they have what condition(s)?
Renal, hepatic insufficiency

ACE inhibitors - acute renal failure, hypotension, hyperkalemia
With ACE inhibitors, you must monitor pts with (hypo/hyper)kalemia.
hyper
What significance do NSAIDs have with elderly?
Interfere w/ prostaglandin synthesis, which also protects gastric mucosa and autoreg of renal blood flow. Signif incidence of GI dz and renal impairment in older pts.
Tylenol is effective if the pt has no Hx of...
hepatic dysfxn, alcohol abuse
In what manner should NSAIDs be dosed?
lowest dose, then incr slowly
CNS drugs have a (enhanced/decreased) effect in older adults.
enhanced
Short half life in CNS drugs result in (more/less) falls.
less
Barbituates and benzodiazepines have (incr/decr) half life in elderly.
incr
What benzodiazepines are better alternatives for elderly? Why?
Alprazolam, Lorazepam, and Tempazepam ("ALT") better since shorter half life.
Desipramine and Trazodone are what kind of drug?
Antidepressants
When drugs are bound to albumin, they (can/cannot) pass the blood-brain barrier.
cannot
T/F - H1-blocking agents can cross the blood brain barrier (why/why not?).
True - since highly lipophilic
T/F - H1-blocking agents can have both depressive or stimulating effects.
True - but mostly depressive in older pts
Most common side effect of H1-blocking agents?
sedation
Older adults are (less/more) sensitive to the cognitive effects of H1-blocking agents?
more
H1-blocking agents are best dosed when?
QHS
Name two H1-blocking agents.
Diphenhydramine (benadryl) and chlorpheniramine OTC.
What is the advantage of 2nd generation H1-blocking agents?
Do not cross blood-brain barrier thus less side effect of CNS depression
H1-blocking agents can be Rxed with Pseudophedrine, but what ADEs should you watch for?
Palpitations, HAs, insomnia in older adults
H2-blocking agents are used for...
peptic and duodenal disorders
H2-blocking agents ADEs?
Safe but HAs and mental confusion possible
H2-blocking agents have contraindication with what drugs?
Cimetidine (inhibitor of P450), drugs metabolized by P450 e.g. benzodiazepines, phenytoin, theophylline, warfarin
Name the anticholinergic drug classes mentioned
Hypnotics and Anti...psychotics, depressants, epileptics, spasmodics, histamines
Anticholinergic drugs and elderly don't mix well because...
Elderly more susceptible to impaired autonomic effects on GI, bladder, CNS; loss of memory and delirium w/ atropine; sudden loss of memory w/ scopolamine
(Incr/Decr) mortality rates w/ antimicrobials in the elderly due to...
Incr due to reduced host-defense mech and rxn to antimicrobials
(Narrow/Broad) antibiotics are preferred in elderly.
Broad
Watch for decr renal fxn in these antibiotics...
Fluoroquinolones, amantadine, tetracyclines (except doxy and minocycline)
What consideration should you take in elderly pts w/ CHF or renal failure taking antacids?
Sodium content in antacids - watch for pts w/ CHF and renal failure
In elderly, antacids alters pH, (incr/decr) acidic drug absorption, and (incr/decr) basic drug absorption.
incr, decr
Alcohol (in consideration of cold/cough meds) can...
potentiate effects of antipsychotics, sedatives, and H1 antihistamines
Older pts w/ what kinds of problems are advised against the used of antihistamines or anticholinergic agents?
Asthma, glaucoma, urinary tract probs
Long term use of laxatives can cause...
disturbances in electrolyte and water balance
What types of laxatives are safest for chronic constipation?
Bulk formers, stool softeners
Megadose vitamin intake is assoc w/...
renal and CNS effects
Niacin side effects...
Alter liver fxn and raise uric acid and glucose in blood
What vitamins affect lab tests?
Vit A and D
Alcohol + CNS depressants = what ADE(s)?
Enhanced depression
Alcohol + Phenothiazines = what ADE(s)?
Inhibition of phenothiazine absorption
Alcohol + Aspirin = what ADE(s)?
GI bleeding
Alcohol + Tetracycline = what ADE(s)?
Divalent cations prevent absorption of drug
Topical Alpha-2 adrenergic ADEs?
oral dryness, fatigue, ocular allergic rxn
Topical nonselective adrenergic blockers (i.e. timolol) ADEs?
bronchial, cardio, CNS effects e.g. fatigue, depression, confusion
Adrenergic agonists ADEs?
Dry upper respiratory passage, HAs, anxiety, tachycardia, hypertensive crisis
T/F - Phenyl only causes tachycardia.
False - can also cause reflex bradycardia
What adrenergic agonist causes subarachnoid hemorrhages and occipital HAs?
Phenyl
T/F - Adrenergic-blocking agents causes constipation.
False - diarrhea
Name two cholinergic agonists.
Pilo, echothiophate
T/F - Pilo can cause GI disturbances.
True
T/F - Echothiophate can cause dryness of the mouth.
False - salivation
T/F - Atropine causes excessive urination.
False - urinary retention (cholinergic antagonist!)
T/F - Atropine decreases the heart rate.
False - tachycardia
T/F - Cyclopentolate causes drowsiness.
True - also restlessness!
T/F - Cyclopentolate causes restlessness
True - also drowsiness!
T/F - Cyclopentolate causes incoherent speech.
True
T/F - Local anesthetics cause bradycardia.
False - tachycardia
T/F - Local anesthetics cause nervousness.
True
T/F - Local anesthetics cause hypotension.
True - and hypertension too!!!
T/F - Topical adrenergic-blocking agents can cause asthma.
True
T/F - Sulfonamides causes contact dermatitis.
False - Exfoliate dermatitis

Neomycin = contact dermatitis
T/F - Chloramphenicol causes erythema multiforme.
False

Sulfonamides = erythema multiforme
What is a cheap alternative to tobradex?
Maxitrol
What is a cheap alternative to Vigamox/Zymar?
Oculflox/Ciloxin
What is a cheap alternative to Pataday?
Zatidor
RDA for elderly in older...
male (177lbs, 77kg) = ? kcal
female (143lbs, 65kg) = ? kcal
2300 kcal
1900 kcal
High protein diets are (more/same/less) digested and absorbed in elderly.
less
__g/kg of protein meets the need for elderly.
1
Carb absorption in elderly (incr/same/decr)?
decr (slightly impaired)
How does fat absorption compare in elderly vs younger?
Equivalent up to 100g, but >120g/day less fat abs; institutionalized even less b/c body doesn't need to store it - don't move that much
T/F - Elderly typically have good vitamin status.
False - inadequate vitamin status common; poor food choices, inadequate dietary intake
Vit A adequacy in elderly? Physiological change?
may be too high; increased absorption
Vit D adequacy in elderly? Physiological change?
too low; decr skin synthesis, decr absorption
Thiamine adequacy in elderly?
adequate
Riboflavin adequacy in elderly?
adequate
Vit B6 adequacy in elderly? Physiological change?
too low; serum homocysteine levels rise when too low
Folate adequacy in elderly?
may be too low
Vit B12 adequacy in elderly?
may be too low
Ascorbate adequacy in elderly?
adequate
Calcium adequacy in elderly?
too low
Iron adequacy in elderly?
adequate
Zinc adequacy in elderly?
adequate
Copper adequacy in elderly?
adequate
Selenium adequacy in elderly?
adequate
Magnesium adequacy in elderly?
too high
Chromium adequacy in elderly?
too high
What supplement type is the standard of care for ARMD?
antioxidants
*Undernutrition is defined as...
- Lose >10lbs in 6 mo
- Lose 4-5% body wt in 1 yr
- Lose 7.5% body wt in 6 mos
AREDS supplement regimen?
Vit C 500mg
Vit E 400IU
Beta carotene 15mg
Zinc 80mg
Copper 2mg
AREDS supplements decreased ARMD by __%
25
Free radical effect on carbohydrates?
breaks chains of hyaluronic acid
Free radical effect on nucleic acids?
genetic defects
Free radical effect on proteins?
fragments plasma proteins, decr body fxns
Free radical effect on lipids?
cellular membrane function destruction (remember elderly tend to have leaner bodies)
How does Vit E in the skin protect vs free radicals?
prevents cell wall damage by reacting w/ free radicals
What role does bilirubin and uric acid play in protecting the body?
scavenge oxyradicals
What role do plasma proteins play in protecting the body?
reduce formation of atheromas on BV walls
Free radicals result in lens (hydration/dehydration)?
dehydration
This harmful behavior diminishes levels of antioxidants, ascorbate, and carotenoids.
Smoking
Hyperbaric chambers cause...
Reduced glutathione, incr glutathione sulfide
T/F - There is a reduced size and frequency of B cell mediated response in the elderly.
False - true for T-cells! No change for B-cells.
How are phagocytosis and the ability to fight cancer in the elderly related?
Antigen processing delayed
What mineral is essential for cell mediated immunity?
Zinc
What mineral is essential for lymphocytic and granulocyte fxn?
Iron
Supplements of Vit C and Zinc in elderly increase ___ and ___ (immune responders).
T-cells and IgG
T/F - Obesity is a risk factor for diabetic retinopathy.
True
What antioxidant is excluded from the nutritional intervention of cataracts?
Vitamin A
T/F - HTN is a risk factor for ARMD.
True