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27 Cards in this Set

  • Front
  • Back
What classes of drugs are most associated w/ ADR in the elderly
1. cardio
2. diuretics
3. anticoags
4. antidepressants
Physiological changes of the kidney
dec renal mass, # & lengths of tubules & GFR --> dec creatine clearance, dc responsiveness to vol depletion and inc drug clearance time
Physiological changes in body mass ratio
dec lean muscle and inc fat --> inc half-life of lipid soluble drugs and incr peak of hydrophillic meds
Physiological changes in the liver
dec hepatic mass, dec blood flow --> dec in metabolism
Does bioavailability of drugs change in geriatrics
No, exceptions:
1. high first pass effect in liver failure
2. enteral feeding
3. incr gastric pH d/t PPI, antacids, etc
4. drugs that promote GI motility
Why does it take older patients to reach steady state?
thinning of the stratum corneum
changes in sebaceous glands
fewer capillaries
Eq for Vd
Vd=cl x half-life/0.693
How does Vd of hydrophillic and lipophilic drugs change
older pt have dec total body water, dec lean muscle mass and inc fat --> hydrophilic drugs - lower Vd
lipophilic drugs - higher Vd
High or Low Vd: alcohol
hydrophilic so low Vd
High or Low Vd:digoxin
hydrophilic so low Vd
High or Low Vd: benzo
hydrophobic so high
How does Vd relate to half-life
directly proportional: inc Vd --> inc t1/2
how do levels of warfarin and phenytoin chg in the elderly
dec albumin -> incr fee conc of highly protein bound drugs
are phase I or II drugs better to use in the elderly
phase II (glucuronidation and acetylation) because it doesn't produce active metabolites
DOC for sedation in elderly
lorazepan (phase II)
what's phase I?
phase 2?
I - oxidation/reduction
2 - glucuronidation/acetylation
How does creatine clearance change
elderly patients have less body mass and therefore make less creatine --> lower than normal values
Cockroft Gault equation
CrCl (mL/min) = (140-age)xbody wt(kg)/scr(mg/dL)x72
mult by .85 for women
When should you adjust the dose for renal insufficiency
Scr <50ml/min
t1/2 inc b/c dec hepatic metabolism
Age-related changes in PK: diazepam
fat soluble drugs have inc t/12 b/c of inc fat
Age-related changes in PK: furosemide
incr t1/2 b/c decr GFR
Age-related changes in PK: warfarin
incr alpha-AGP --> dec free concentrations
Changes in benzos in the elderly
Cognitive, psychomotor impairment, increased analgesic effect
Does the pneumococcal vaccine work
Yes. It dec the incidence of pneumonia and dec length of stay
Do anticholinergic drugs incr the progression of mild cognitive impairments
No, but be careful when using these drugs
Which are better conventional antipsychotics or atypicals?
Neither. Both have have mortality rates. THM: demential is NOT psychosis so don't treat as such