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Geri Test1 - Pharmacological Aspects of Aging

Terms in this set (87)

13, 30
Patients aged 65 years and older represent
_____% of the population and take approximately
_____% of all prescription medications in the US
90, 40
_____% of patients over 65 take one drug/week
- 40% use 5 drugs/week
- 12% use over 10 drugs/week (oldest old)
_____% take OTC meds and/or dietary supplements - always ask in case Hx! Many think they don't count if they're "natural" but can cause ocular SE
female, 7-8
In general, do more elderly females or males take medications? ___________
• Frail elderly (oldest old) take approximately ______ medications on average
Polypharmacy
Issues with medication efficacy and safety:
-______________ issues: if patient buys different drugs from different pharmacies, pharmacist can't counsel pt about drug interactions
40, stomach ulcers
Gastric acid secretion in elderly is decreased by ______%, altering pharmacokinetics/dec absorption
• Acid that normally helps break down drugs is decreased - likelihood for _____________ and gastric distress is higher
Ca, Fe, MTV (max tolerated volume)
Factors affecting absorption of medications:
- secretion of gastric acid decreased by 40%
- decreased levels of _____ and _____ in body
- diseases, food or concurrent drugs
- decreased _________ to medications
distribution
All of the following affect _________ of medications:
-body composition
-blood flow, plasma binding
-body water content dec by 10% (bad for water soluble drugs)
-body fat inc - fat soluble drugs (ex. anesthesia) bind to lipids and stay longer, more SE
water, body fat
Elderly patients have a 10% lower ______ content and increased __________ content - take this into account when Rx water vs lipid (ex. anesthesia) soluble drugs
lipid (higher fat content in body)
Are elderly patients more likely to have increased side effects with water or lipid soluble medications?
albumin
Pharmacokinetics issues:
-Protein binding is affected by decreased levels of serum ________
• Unclear clinical effect
metabolism
All of the following affect _________ of medications:
- Liver function/enzymes
- Hepatic blood flow
- Smoking
cytochrome P450, glucuronide
Metabolism of medications is affected by hepatic function/enzymatic activity:
• ____________ needed for Phase I
• ____________ needed for Phase II
35
Hepatic flow is decreased by 40% after age____ y/o
• Dec liver function means dec metabolism/breakdown of drugs and other substances
liver, kidney
________ function is important for metabolism of medications in the body
________ function is important for elimination
metabolism, elimination
Hepatic function is important for ____________ of medications in the body
Renal function is important for ____________
glomerular, creatinine
Drug elimination:
-Dec renal flow and __________ filtration means more drugs stay in the body, inc probability of SE
- Rate of _________ clearance dec by 35%
35, surgery, herpes
Drug elimination:
-Rate of creatinine clearance dec by ____% in elderly patients BUT can inc after ________ or during treatment for _________ (must monitor closely with labs for kidney function during Tx)
smoking, water
Environmental/lifestyle factors:
- Dietary intake
- ___________ and not enough ______ intake reduces metabolism and renal clearance, inc side effects
metabolism (liver), renal, SE
Environmental/lifestyle factors:
- Dietary intake
- Smoking and not enough water intake reduces __________ and ______ clearance, inc chances of _____
ibuprofen, naproxen 250
The following analgesic/anti-inflammatory meds are contraindicated in patients with decreased hepatic function:
-_____________ (absolute contraindication)
-_____________ in doses higher than ______mg bid
naproxen, renal
Patients with decreased hepatic function may NOT take ibuprofen - can take low dose (<250) ___________ UNLESS ________ function is also compromised
ciprofloxacin, gentamycin, tobramycin
Name 3 antibiotics that are contraindicated in patients with decreased renal function
F (only if renal fcn is dec)
T/F: Many common antibiotics such as gentamicin and tobramycin are contraindicated in patients with decreased hepatic function.
propanolol, digoxin
-Which cardiovascular drug is contraindicated in patients with decreased hepatic function?
-Which cardiovascular drug is contraindicated in patients with decreased renal function?
renal, colorblindness
Digoxin (cardiovascular drug) is contraindicated in patients with decreased ________ function and can cause ____________ (ocular SE)
furosemide, hydrochlorothiazide, triamterene, amiloride
Name 4 diuretics that are contraindicated in patients with decreased renal function
Diuretic, renal, myopic shift (IF patient is phakic)
__________ drugs such as furosemide, hydrochlorothiazide, triamterene, and amiloride are contraindicated in patients with decreased ________ function and can cause ____________ (ocular SE)
F (only occurs in phakic patients)
T/F: Diuretics such as furosemide, hydrochlorothiazide, triamterene, and amiloride may cause a myopic shift in patients post-cataract surgery.
alprazolam, diazepam, imipramine, trazodone, triazolam
Name 5 psychoactive drugs that are contraindicated in patients with decreased hepatic function
renal, hepatic
-Diuretics are contraindicated in patients with decreased ________ function
-Psychoactive drugs are contraindicated in patients with decreased ________ function
Diuretic, psychoactive
-___________ drugs such as furosemide, hydrochlorothiazide, triamterene, and amiloride are contraindicated in patients with decreased renal function
-___________ drugs such as alprazolam, diazepam, imipramine, trazodone, and triazolam are contraindicated in patients with decreased hepatic function
Antacids
___________ are the most common OTC med (after vitamin/supplements) taken by geriatric pts
• Sodium interferes with absorption by creating a coating in the stomach and with elimination by inhibiting water and leading to constipation
absorption, elimination, constipation
Antacids are the most common OTC med (after vitamin/supplements) taken by geriatric pts
• Sodium interferes with ___________ by creating a coating in the stomach and with ___________ by inhibiting water and leading to ___________
aspirin, alcohol, laxatives
OTC drug effects on elderly patients:
- Analgesics such as ___________ may cause ulcers
- Cough/cold remedies - high ___________ content
- ___________ often taken for constipation caused by antacids - can cause an electrolyte imbalance
ulcers, antacids, electrolyte
OTC drug effects on elderly patients:
- Analgesics such as aspirin may cause ___________
- Cough/cold remedies - high alcohol content
- Laxatives often taken for constipation caused by ___________ - can cause an ___________ imbalance
Niacin, CME
Vitamins may cause toxicity in high quantities!
• __________ affects liver function, interferes with blood levels of uric acid and glucose
-visual SE: can cause _______
liver, uric acid, glucose
Vitamins may cause toxicity in high quantities!
• Renal and CNS effects
• Niacin affects _______ function, interferes with blood levels of __________ and __________
-visual SE: can cause CME
binding, receptor
Pharmacodynamics of drugs in the elderly are affected by:
- receptor ___________ due to reduced albumin levels
- post-________________ effects - less alpha and beta receptors available
albumin, alpha, beta
Pharmacodynamics of drugs in the elderly are affected by:
- Receptor binding due to reduced __________ levels
- Post receptor effects - less __________ and __________ receptors available
- Chemical interactions
anticholinergic, uveitis (no reason to cyclo an elderly pt)
Elderly patients are especially sensitive to ______________ drugs such as:
• Tricyclic antidepressants
• H1 antihistamines
• Atropine - caution when using to Tx ________
Tricyclic, H1 (ex. benadryl, zyrtec, allegra, claritin), Atropine
Elderly patients are especially sensitive to anticholinergic drugs such as:
• __________ antidepressants
• ______ antihistamines
• __________ - caution when using to Tx uveitis
Warfarin, inc
___________ is an anticoagulant whose action of increasing PT (prothrombin time) is _____ (inc/dec/not affected) by aging
phenylephrine
___________ is a cardiovascular drug whose action of causing acute vasoconstriction is NOT affected by aging
Timolol
___________ is a beta blocker whose action of decreasing HR is NOT affected by aging
Furosemide
___________ is a diuretic whose action of causing inc latency of peak response is DECREASED by aging
Diazepam
___________ is a psychoactive drug whose action of sedation is inc by aging
Diphenhydramine (Benadryl)
___________ is an antihistamine whose action of dec psychomotor function is increased by aging
warfarin, diazepam, diphenhydramine
Which of the following drugs' actions are INCREASED by the effects of aging?
-Warfarin
-Phenylephrine
-Timolol
-Furosemide
-Diazepam
-Diphenhydramine
furosemide
Which of the following drugs' actions are DECREASED by the effects of aging?
-Warfarin
-Phenylephrine
-Timolol
-Furosemide
-Diazepam
-Diphenhydramine
phenylephrine, timolol
Which of the following drugs' actions are NOT affecting by the process of aging?
-Warfarin
-Phenylephrine
-Timolol
-Furosemide
-Diazepam
-Diphenhydramine
80, iatrogenic (caused by meds)
It is common for elderly patients to have multiple ocular and/or systemic diseases at once:
-______% have one or more chronic disease: look for visual SE of DM, HTN, stroke
• Be aware of ___________ side effects and interactions from treating multiple conditions simultaneously
IV (intravenous), stomach pH
Ophthalmic drugs enter circulation directly - mimics ___________ administration
-benefit of not disrupting ____________ (common complaint/SE of elderly patients)
inc
When Rx ophthalmic drugs, keep in mind that inflamed mucus membranes _____ (inc/dec) absorption of medication
-inflamed conjunctiva, scratched cornea (injury, rubbing, Goldmann stamp)
NLO (nasolacrimal obstruction), 1 min
When Rx ophthalmic drugs, keep in mind that inflamed mucus membranes INCREASE absorption -to avoid this (in cases of conjunctivitis, scratched cornea, Goldmann stamp, etc), may perform ____________ for a duration of _________ on each side to decrease absorption of drops
HR, HTN
Phenylephrine's effects are not affected by the process of aging, HOWEVER keep in mind that it will increase _____ and should be avoided in patients with _______ (common disease in elderly)
dry eye
Topical ophthalmic anesthetics such as proparacaine 0.5% or benoxinate 0.4% have minimal SE UNLESS patient has severe ________ - corneal epithelium is compromised
Phenylephrine 2.5%
Which mydriatic is the safest to use in elderly patients?
10 min, A1, dilator
Phenylephrine 2.5% is the safest mydriatic to use in elderly patients
• Peak plasma concentration = ______________
• Direct adrenergic agonist - acts on ______ receptors in the ___________ muscle
10, brady, CO (cardiac output)
SE of Phenylephrine:
-INC systolic and diastolic BP
» 1 drop of 2.5% usually does not inc BP but higher dose or concentration can:
-_____% is NOT recommended for elderly patients
-can cause compensatory ________cardia and reduced _______
Phenylephrine 10
SE associated with ___________ (mydriatic) _____% - avoid in elderly patients!
- Intracranial Hemorrhage
- Cardiac arrhythmias
- Hypertensive crisis
tropicamide, parasympathetic
Phenylephrine may increase HR - in patients with HTN, best to use ______________
-is a cholinergic antagonist - works in the ________________ nervous system
-acts on M receptors in striated muscles in the ciliary body and sphincter
-less dilation
cholinergic antagonist, M
Phenylephrine may increase HR - in patients with HTN, best to use Tropicamide
-is a ________________ - works in the parasympathetic nervous system
-acts on _____ receptors in striated muscles in the ciliary body and sphincter
-less dilation than phenylephrine
8 min, 0.5
Cyclopegics: Atropine Sulfate
• Peak plasma concentration ocuurs after ___________
• 0.5, 1, 2, and 3% solutions available - dose related side effects develop after _____mg
• SE = tachycardia, mouth dryness
5, 10
Atropine avoided in elderly patients due to SE:
-at ____mg concentration, Atropine can cause SE of restlessness, confusion, difficulty with speech, flushed skin, decreased peristalsis (digestion)
-at ____mg can cause serous toxicity, ataxia, hallucinations, coma, convulsions
cyclopentolate
Cyclopegics: _______________ 0.5%, 1% and 2% ophthalmic solutions
• Usually used in children for cyclorefractions
• Good for Tx of uveitis or trauma in elderly
- NOT used for DFE - lasts 6-12 hours, tropicamide gives better and faster dilation with minimal side effects
cyclorefraction, uveitis, trauma
Cyclopegics: Cyclopentolate Hydrochloride 0.5%, 1% and 2% ophthalmic solutions
• Usually used in children for _______________
• Good for Tx of _______ or _________ in elderly
6-12, tropicamide
Cyclopentolate is NOT used for DFE - lasts ______ hours, ____________ gives better and faster dilation with minimal side effects
8.3, 10-15
Cyclopentolate has peak concentration at _____mg/ml at ________ minutes
1.3-5.2, 5
Tropicamide has peak concentration of _________ mg/mL at ____ minutes
inc IOP, POAG
Most important SE of tropicamide = _________
-contraindicated in patients who have ______ - can R/O with a quick penlight examination
antiviral, GI distress
Ophthalmic and systemic ___________ medications such as trifluridine, acyclovir, ganciclovir can cause SE such as headaches, rash, urticaria, and the most common complaint among elderly, ____________ leading to poor compliance
cardiac
When prescribing medications such as beta blockers, be aware of other systems that may be affected - __________ = most common and most important condition to consider
Bradycardia
Be aware of other medications that may cause cardiac SE - the following can cause _______________
- Cardiac glycosides
- Calcium-channel blockers
- Quinidine
betaxolol
When prescribing beta blockers, if CNS side effects (such as depression, fatigue, hallucinations, sexual dysfunction, sleep disturbances) are a concern, _________ is a better choice than Timolol
bitter taste, RE (refractive error)
Topical CAIs including Dorzolamide 2% (Trusopt) and Brinzolamide 1.8% and 3% (Azopt) can cause SE of _____________ (most common complaint)
-ocular SE = changes in _______________
-irritation, FBS, hypersensitivity to sulfonamides
sulfonamides, COPD
Topical CAIs (Dorzolamide, Brinzolamide) are contraindicated in patients who are allergic to _____________, have respiratory conditions like _______, or have hepatic or renal insufficiency
dry mouth, MAO inhibitors (and caution in patients with CVD)
Most common SE of alpha 2 agonists like Brimonidine 2% (Alphagan) = ____________
-contraindicated if pt is taking _____________
hypersensitivity
Most important consideration for Augmentin (Amoxicillin Clavulanate)
-Beta-lactamase type of penicillin
3rd gen (and above) cephalosporin
If patient is allergic to penicillin, ______________ is next best choice
EES (Erythromycin), 5
_______ is a macrolide anti-infective drug that usually does NOT cause SE when used topically
-standard _____day Tx for control of any infection
2300, 1900, diabetic
Due to decline in gastrointestinal function in elderly patients, RDA (Recommended Dietary Allowance) is _________ Kcal older men, _________Kcal for women 51 years and older
• _________ patients have reduced metabolism, require even less calories
DCCT (Diabetes Control and Complications Trial)
The ____________ demonstrated that strict regulation of blood sugar with frequent use of injections and proper diet dramatically reduces complication rate of diabetes
(moderate to intermediate) drusen, macular degeneration
Age Related Eye Disease Study (AREDS) demonstrated that patients of ANY age who have extensive _________ or who have advanced _______________ in one eye should consider taking a supplement
AREDS (Age Related Eye Disease Study), 25
_________ demonstrated that patients of ANY age who have extensive moderate to intermediate drusen or who have advanced macular degeneration in one eye should consider taking a supplement - reduces probability of progression by _____%
Vitamin C (Ascorbate)
______________ can be taken to reduce rate NS progression BUT increases prevalence of
cortical cataracts
NS, cortical cataracts
Ascorbate (Vitamin C) can be taken to reduce rate of _______ progression BUT increases prevalence of
___________________
Vitamin E, 400
_______________ supplements cause a 56% lower probability of developing cataracts if more than ________ IU is taken
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