18 terms

Geriatric Pharmacology

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What are the GI Physiologic Changes of Aging?
Decreased gastric acidity.
Decreased gastrointestinal blood flow.
Delayed grastric emptying.
Slowed intestinal transit time.
What are the special considerations of drug administration for elderly?
1. Antacids decrease absorption of acidic drugs: digitalis, phenytoin, tetracycline.
2. Anticholinergics: Slow GI motility and absorption rate.
Older adults have Decreased Total body water. What are the drug considerations?
Decreased Volume Distribution, thus
1. Increased Plasma Conc. of water soluble drugs.
2. Lower doses are required: Lithium, digoxin, ethanol, etc.
Older adults have Decreased Lean body mass and Increased body fat. How does it change elder's pharmacokinetics?
It increases drug distribution and longer half life of water soluble drugs and Accumulation into fat of lipid soluble drugs: Benzos, etc.
Older adults have Decreased Serum Albumin. What does it affect and any drug consideration for that?
Increased unbound fraction of highly protein bound drugs.
Binds acidic drugs: warfarin, phenytoin, digitalis, etc.
Older adults have Decreased Alpha1 Acid glycoprotein. What does it affect and any drug consideration for that?
Increased unbound fraction of highly protein bound drugs.
-Binds basic drugs: lidocaine and propranolol, etc.
How is metabolism determined?
- Primarily by hepatic function and blood flow.
- Capacity of the liver to metabolize drugs does not appear to decline consistently with age for all drugs.
How is elimination determined?
- Primarily by renal function.
- Declines with age and is worsened by co-morbidities.
- Decline is not reflected in an equivalent rise in serum creatinine since creatinine production is reduced due to lower muscle mass.
What are the renal changes with aging and how does it affect clinically?
Physiologic change:
1. Decreased GFR.
2. Decreased renal blood flow.
3. Decreased renal mass.

General clinical effect:
Decreased clearance, Increased half life of renally eliminated drugs
What are the possible reasons that elders have enhanced sensitivity of drugs?
may be due:
1. Changes in receptor affinity.
2. Changes in receptor number.
3. Post-receptor alteration.
4. Age-related impairment of homeostatic mechanisms. e.g.: decreased baroreceptor reflexes.
Which CNS drugs require extra caution and monitoring for elders?
Sedative-hypnotics: Benzodiazepines and barbiturates.
Analgesics: Opioids.
Antipsychotic, antidepressants: Haloperidol, lithium, TCAs.
Which cardiovascular drugs require extra caution and monitoring for elders?
Antihypertensives: Thiazides, beta-blockers
Which antimicrobial drugs require extra caution and monitoring for elders?
Beta-lactams (penicillins, cephalosporins, carbapenems, and monobactams) and aminoglycosides (amikacin, arbekacin, gentamicin, kanamycin, neomycin, netilmicin, paromomycin, rhodostreptomycin, streptomycin, tobramycin, and apramycin): these decrease clearance
Which antiarrhythmic drugs require extra caution and monitoring for elders?
Quinidine and procainamide: decrease clearance and increase half life.
Which anti-inflammatory drugs require extra caution and monitoring for elders?
NSAIDs: GI bleed and irritation
What are the recommendations to improve compliance?
1. Take careful drug history.
2. Prescribe only for a specific and rational indication.
3. Define goal of drug therapy.
4. High index of suspicion regarding drug reactions and interactions.
5. Simplify drug regimen.
What is The first-pass effect of medication?
also known as first-pass metabolism or presystemic metabolism is when an administered drug enters the liver and undergoes extensive biotransformation and thus decreasing the concentration rapidly before it reaches its target.
The first-pass effect of medications is __________________ in the geriatric population.
Decreased