GERIATRIC

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bernalooo

Cards (46)

What age is considered elderly in the context of geriatric pharmacology?
Over 65 years old
What age is classified as geriatric?
Over 75 years old
What happens to drug changes as individuals age?
Important changes in some drugs occur with increasing age in many individuals
How do drug usage patterns change with age?
They change due to the increasing incidence of disease with age
What general changes in the lives of older people affect drug usage?
Increased incidence of several simultaneous diseases
Nutritional problems
Reduced financial resources
Decreased dosing adherence
What is the evidence regarding drug absorption in the elderly?
There is little evidence of any major alteration in drug absorption with age
What conditions associated with age may alter drug absorption rates? 
Altered nutritional habits, greater consumption of non-prescribed drugs, and changes in gastric emptying time
What happens to the functional capacity of major organ systems as people age?
There is a decline beginning in young adulthood and continuing throughout life
How do elderly individuals accumulate deficiencies over time?
Elderly do not lose specific functions at an accelerated rate but accumulate more deficiencies with time
What are the changes in body composition in elderly adults that affect drug distribution? 
Reduced lean body mass
Reduced body water
Increased fat as a percentage of body mass
Decreased serum albumin
Increased serum orosomucoid (α-acid glycoprotein)
How do changes in body composition affect drug dosing in the elderly? 
These changes may alter the appropriate loading dose of a drug
What is the major organ for drug clearance in the elderly?
The kidney
What percentage of the population experiences a decline in creatinine clearance with age?
About 2/3 of the population
Why is serum creatinine alone not an adequate measure of renal function in the elderly?
Because the decline in creatinine clearance is not reflected in an equivalent rise in serum creatinine
What formula can be used to correct for reduced renal clearance in elderly patients?
The Cockcroft-Gault formula
What is the Cockcroft-Gault formula for creatinine clearance? 
$\text{Creatinine clearance (mL/min)} =$ $\frac{(140 - \text{age}) \times (\text{weight in kg})}{72 \times \text{serum creatinine in mg/dL}}$
How should the creatinine clearance for women be adjusted in the Cockcroft-Gault formula?
It should be multiplied by 0.85 due to reduced muscle mass
What is the significance of homeostatic response in geriatric pharmacology?
Homeostatic responses are important components of the overall response to drugs and may change the pattern or intensity of drug response
What are some pharmacodynamic changes in elderly patients?
Increased sensitivity to sedative-hypnotics and analgesics
Decreased responsiveness to β-adrenoreceptor agonists
Increased average blood pressure and orthostatic hypotension
Impaired temperature regulation
What are the major changes in behavior and lifestyle that affect geriatric pharmacology?
Changes result from cognitive changes, economic stress, and loss of a spouse
What are the pharmacokinetic changes associated with sedatives and hypnotics in the elderly?
Half-life increases by 50-150% between ages 30-70
Both parent molecule and metabolite of some benzodiazepines are pharmacologically active
Age-related decline in renal function and liver disease contribute to reduced elimination
What are the pharmacokinetic changes associated with opioid analgesics in the elderly?
There are variable changes in pharmacokinetics, and elderly patients are often more sensitive to respiratory effects
What are the concerns regarding the use of antipsychotic and antidepressant drugs in the elderly?
Heavily used and possibly misused for psychiatric diseases
Antimuscarinic effects may worsen memory impairment
Sedative effects may mask true improvement in agitated patients
Increased risk of orthostatic hypotension with certain medications
What is the role of lithium in geriatric pharmacology?
Lithium is often used for the treatment of mania in the aged and is cleared by the kidneys
What should be done when thiazides are used with lithium in elderly patients?
Thiazides reduce the clearance of lithium, necessitating dosage reduction and frequent measurement of lithium blood levels
What are the recommended antidepressants for elderly patients?
Tricyclic antidepressants with decreased antimuscarinic effects (e.g., Nortriptyline, Desipramine)
Selective Serotonin Reuptake Inhibitors to minimize autonomic effects
What are the treatment options for Alzheimer's Disease?
Cholinomimetic drugs
Monoamine Oxidase (MAO) inhibitors
N-methyl-D-Aspartate (NMDA) antagonists
Lipid-lowering statins
PPAR-γ agents
What is Memantine and its role in treating Alzheimer's Disease?
Memantine is an NMDA antagonist that is better tolerated and less toxic than cholinesterase inhibitors
What are the considerations for antihypertensive drugs in the elderly?
Blood pressure, especially systolic, increases with age
Hypertension should be treated vigorously
Use low hypertensive doses rather than maximum diuretic doses
Non-drug therapy is encouraged
What are the common side effects of diuretics in elderly patients?
Hypokalemia, hyperglycemia, and hyperuricemia are more relevant in the elderly
What is the role of calcium channel blockers in geriatric pharmacology?
They are effective and safe if titrated to the appropriate response
What are the risks associated with beta blockers in elderly patients?
They are hazardous in patients with obstructive airway disease and less useful unless heart failure is present
What is the effect of ACE inhibitors in elderly patients?
They are less useful unless there is heart failure or diabetes
What is the mechanism of action of Minoxidil?
Minoxidil decreases blood pressure by relaxing the muscle in the walls of blood vessels
What are the risks associated with digoxin in the geriatric population? 
Toxic effects are dangerous, and clearance and volume of distribution are usually decreased in old age
What factors contribute to the high incidence of digitalis-induced arrhythmias in geriatric patients?
Hypokalemia, hypomagnesemia, hypoxemia, and coronary atherosclerosis
What challenges are associated with treating arrhythmia in the elderly?
The lack of good hemodynamic reserve, frequency of electrolyte disturbances, and high prevalence of severe coronary disease
What are the pharmacokinetic changes of quinidine and procainamide in the elderly?
Clearances and half-lives increase with age
What is the primary concern regarding antimicrobial drugs in geriatric patients?
Age-related changes contribute to the high incidence of infection
What is the relationship between the number of drugs taken and the incidence of adverse drug reactions in the elderly?
The percentage of adverse reactions increases from about 10% with one drug to nearly 100% with ten drugs