Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
29 Cards in this Set
- Front
- Back
|
drug responses do they increase or decrease in elderly
|
both depends on drug
|
|
|
basis for altered drug responses in elderly (3)
|
kinetics
dynamics drug interactions |
|
|
is absorption affected by age
|
NO (not significantly affected)
|
|
|
changes in drug distribution with age?
|
yes
increase in fatty tissue with age Vd for lipid soluble drugs increases with age Vd for water soluble drugs decreases with age |
|
|
with age have ____in serum albumen (protein that many drugs bind to)
|
decrease
|
|
|
decreased albumin= ____ drug-protein binding
|
decrease
*affects drug distribution |
|
|
In a hypoalbuminemic patient
Normal total serum [drug] = |
Higher free [drug]
|
|
|
half life ___with age
|
increase
|
|
|
with aging is phase 1 rxn or phase 2 impaired
|
phase 1 (phase 2 not as impacted)
*pediatrics opposite to this |
|
|
GFR (renal excretion)____with aging
|
decreases
|
|
|
bioavailability
|
-drugs like oral pass through liver so dont get 100% of it into circulation like IV
-what you get into circulation=bioavailability |
|
|
______bioavailability of drugs that affected by first pass effect with aging
|
increased = more drug in circulation than you may want
|
|
|
clearance ____with aging
|
decreases
|
|
|
(5) physiological changes in the elderly relevant to drug handling
|
decrease in body mass
change in body composition decrease serum albumin decrease liver blood flow/size decrease renal function |
|
|
do pharmacodynamics change with age
|
its possible
possible changes in receptor density/physiological changes |
|
|
with age you have decreased sensitivity of heart to the _____receptor agonist terbutaline
|
adrenergic beta
|
|
|
with age the altered baroreceptor function cause pulse rates to___in order to....
|
increase to maintain BP a
|
|
|
does nifedipine affect young or older men
what does it do |
young
increase pulse to maintain BP *with age have altered baroreceptor function |
|
|
what (5) reasons for increased risk of adverse drug reactions
|
-change in kinetics
-change in dynamics -polypharmacy (too many meds) -physical/psychiatric comorbidity -failure to differentiate if adverse drug effect due to drug or just aging |
|
|
drug with highest drug drug interaction tendency
|
anticoagulants
|
|
|
due to drug drug interaction in elderly you can get drug displacement from proteins if (3)
|
-displacing drug given in high doses
-AVD of displaced drug is small -response of the drug occurs faster then redistribution or enhanced elimination |
|
|
another problem of drug drug interaction is enzyme interactions, explain
|
second drug enhance metabolizing enzyme of first drug= less of the first drug or if second drug inhibit metabolizing enzyme then get more of first drug
|
|
|
warfarin =
|
oral anticoagulant
*warfarinpatients have wide range of possible doses they could be given (patient specific) |
|
|
warfarin inhibits____which decreases_____and causes synthesis of
|
-vitamin K epoxide reductase
-amount of reduced vitamin K -partially carboxylated sub-functional coagulation proteins in liver |
|
|
cimetidine=
|
inhibits cyp450 2c9--> inactive metabolites of warfarin-> increase free warfarin
|
|
|
increase warfarin= ____prothrombintime
|
increase
|
|
|
barbituates___warfarin levels by
|
decrease
inducing cyp450 2c9 increase prothrombintime |
|
|
error of compliance=
|
sice taking so many drugs elderly tend to forget to take them about 60% error rate
*different error rate for different drugs |
|
|
guidelines for drug prescribing in elderly
1. Know all the patient’s medical problems and all the drugs being taken, including OTC. 2. Know the pharmacology of the drugs. Consider Guidelines for drug prescribing in the elderly cost. 3. Start with small doses and titrate the response. 4. Keep dosage regimens simple. 5. Check that visual, motor or cognitive impairments will not result in errors or noncompliance. 6. Consider that new symptoms may be drug-related. |
tru dat
|
