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Medications and the Elderly

Terms in this set (92)

What is pharmacokinetics?
study of the time it takes for drugs to be liberated, absorbed, distributed, metabolized, and excreted
What are the factors that influence the processing of drugs?
age, disease, presence of other medications or food in body, body weight and composition, genetics, environment
What is pharmacodynamics?
biochemical and physiological effects of drugs
True or false. Individuals respond different to the same drug therapy.
true
Gene variation may contribute to ___% of variations in drug disposition, including ADRs.
20-95
What are the stages of drug response?
LADME - liberation, absorption, distribution, metabolism, excretion
What happens during the liberation stage of the drug response?
- coating (around drug) dissolves
- point at which the active drug is release into body
- no significant age-related deficits
What happens during the absorption stage of the drug response?
- how the body takes in medication
- done through mouth, stomach, intestines
In OAs, how does a higher pH in the stomach affect the absorption stage of the drug response?
reduces the absorption of some drugs
In OAs, how does a lower GI motility affect the absorption stage of the drug response?
some of the drug becomes inactive before absorption
What happens during the distribution stage of the drug response?
- drugs are sent to various parts of the body
- many drugs bind to blood proteins
If not bound, drugs are "free" they are _____.
metabolized, excreted
Do OAs have more or less plasma proteins in blood?
less
OAs have ___% fewer plasma proteins in blood.
13
What are the effects of OAs having plasma proteins in blood?
- less binding sites
- more free drugs in blood stream
- more competition for binding sites
What happens during the metabolism stage of the drug response?
drug change/destruction
Where are the majority of drugs processed?
liver
The liver processes drugs into what?
metabolites
What are the changes in liver function for OAs?
- decreased blood floe and enzyme activity
- increased risk for drug toxicity
______ are passed through the kidneys for excretion.
metabolites
Metabolites are passed through the ______ for excretion.
kidneys
Metabolites are passed through the kidneys for ______.
excretion
Grapefruit juice can blood the metabolism of some drugs. Does this increase or decrease the amount of drug in the body?
increase
What happens during the excretion stage of the drug response?
through urine, feces, exhalation, perspiration, saliva
True or false. Drugs in OAs, have a shorter half-life.
false
What is the half-life of a drug?
time for drug to decrease by 50%
Why is the half-life of drugs in OA longer?
- reduced blood flow to kidneys
- fewer nephrons, less efficient kidney function
- kidney disease
When will drug accumulation in blood occur?
if drug is taken in a time frame shorter than 1.5 its half-life time
___% of OAs use 5+ prescription medications.
39
OAs represent ___% of the population.
13
OAs represent 13% of the population but consume at least ___ of all prescription drugs and ___% of all non-prescription drugs used by the population.
1/3; 40
What age group are the biggest users of prescription drugs?
OAs (65+)
OAs are the biggest users of prescription drugs, yet ___% of clinical trials between 1991 and 2000 excluded people 75+ from participating.
40
How many deaths per year are attributed to drug side effects?
30,000
How many hospital admissions per year are attributed to drug side effects?
1.5 million
Before 1989, standard medication dosages were based on what?
150lb Caucasian men aged 20-26 years old
What is the leading cause of morbidity and mortality in the US?
adverse drug reactions
What can adverse drug reactions cause?
- serious disability or temporary/permanent harm
- hospitalization, prolonging care, increasing care need
- death
It is estimated that ___% of OAs on medicare didn't take medications as prescribed over the previous 12 months.
40
What are contributing factors to adherence?
- complex medication schedules
- lack of doctor-patient discussion
- memory/cognitive impairment
- inability to hear or see well
- loss of hand/finger dexterity
- unpleasant side effects (dry mouth, frequent urinations)
- lack of literacy skills
- cost
- don't believe they need medication
What are ways to promote adherence?
- assessing reasons for noncompliance
- attempting to simplify a complex drug schedule
- offering information to help decrease drug costs
- offering educational sessions
- encouraging pill containers that separate by time/day or use a computer-automated pill dispenser and reminders
the average medicine cabinet has ____ OTC drugs.
24
Over ____ prescription drugs have become OTC in the last 15 years.
700
OAs treat themselves with OTC drugs ___% of the time.
69-85
What are the most common OTC drugs?
analgesics (pain), laxatives (constipation), antacids (gastric reflux), cough meds, vitamins, pepto-bismol, non-steroidal topical medications
What are analgesics for?
relieve pain
What are laxatives for?
relieve constipation
Who approves OTC drugs?
FDA
The FDA approves OTC drugs for what?
safety and effectiveness
Are OTC drugs a higher or lower dosage than prescription?
lower
What are generic drugs known by?
common active chemical ingredient in a drug
What does it mean if 2 drugs are "generically equivalent"?
- drugs are chemically the same, but may have pharmacokinetic differences
- differences can be found in coating, dyes, binding agents, etc. that are determined by the manufacturer
What does therapeutically equivalent mean?
- identical active ingredient
- same concentration
- same dose
- LADME stages are the same
What does bioequivalent mean?
extent and absorption of the generic drug is not less than 20% or 25% greater than the drug with the brand name
What does generic equivalent mean?
same drug chemically, but may be different pharmacokinetics
Drugs are approved for human use approximately how many years after discovery?
12
The process of getting drugs approved takes ~$____.
800 million
How long do drug patents last?
17 years
Why do some physicians recommend avoiding using generic drugs for some conditions?
potential differences in pharmacokinetics
Do brand names or generics save money for medicare/medicaid, insurance companies, etc.?
generics
Why are generics generally cheaper?
the companies didn't spend money on research, they just remade the drug
What is the Beers Criteria?
list that identifies medications that pose potential risks outweighing potential benefits for those 65+
What age group widely uses the Beer's Criteria used?
OAs (65+)
What criteria is used widely used in geriatrics clinical care, training, research, and healthcare policy to develop quality measures?
Beers Criteria
What criteria is used to prevent side effects that may be life-threatening and other ADRs?
Beers Criteria
The Beers Criteria contains 3 lists. What are they?
1. potentially inappropriate meds for OA
2. inappropriate meds for OA who are taking other meds or have certain diseases
3. meds for OA advised to use with caution
What are the psychological factors of drug misuse?
- cognitive impairment
- depression/psychiatric
- knowledge/communication
- complex med schedules; many meds
- medication use is perceived as a threat or sign of weakness
- fear of addiction, fear of high risk drugs
What are the physiological factors of drug misuse?
- visual impairment
- hearing impairment
- arthritis and degenerative diseases causes pain, weakness
- pain (especially chronic pain)
- overmedication is possible
- allergic reactions
What are the social factors of drug misuse?
- reduced financial income
- religious or cultural beliefs may influence adherence
- wanting to avoid the "sick role"
What are the other factors of drug misuse?
- swapping meds with friends
- stopping medication use prematurely, over- or under-dosing, using outdated medication
- easy or difficult access
- consuming drugs that have been prescribed by multiple physicians
- using alcohol, caffeine, smoking, or eating contraindicated foods
What is DSM-5?
alcohol use disorder (AUD)
What adults are at low risk for developing AUD?
- men: 4 or less a day, 14 or less a week
- women: 3 or less a day, 7 or less a week
What OAs are at low risk for developing AUD?
3 or less a day, 7 or less a week
~___% of OAs in the US binge drink.
10
What is considered binge drinking?
- men: 5+
- women: 4+
What are the physical effects of alcoholism on the CNS?
- visual impairment
- memory impairment
- body instability
- increased fall risk --> fracture & head injuries
- confusion
- depression
What are the physical effects of alcoholism on the cardiovascular system?
- increased BP
- arrhythmias
- influence coronary artery disease development
What are the physical effects of alcoholism on the gastrointestinal system?
- malnutrition
- nausea
- vomiting --> electrolyte imbalance
- decreased vitamin B12 absorption
What are the physical effects of alcoholism on the metabolic?
- diabetes
- osteomalacia
- liver toxicity -->cirrhosis
What are the risk factors for alcoholism?
- sex (male)
- history of psychological/psychiatric issues
- low education
- low income
- retirement
- disability
- life transitions
- loss
- relocation
What are the 2 groups of alcoholism?
early onset and in response to aging or loss
What is early onset alcoholism?
- 2/3 of cases
- began drinking at young age and continue as OA
What is alcoholism in response to aging or loss?
- 1/3 of cases
- begin as OA in response to aging or loss
True or false. It is recommended that OA drink more.
false
How is drinking different for OA?
- sarcopenia: age-related muscle loss, higher blood alcohol levels
- liver: digest/clear alcohol out of system slower
- water content: have less water --> alcohol is less diluted
- reserve capacity: have less, so it can cause issues
What is the treatment for alcoholism?
- detoxification: stop drinking in a safe manner
- education: how to avoid, how it affects body
- counseling: alcoholism often stems from something else
- continued treatment/support
What are the interactions between aspirin and alcohol?
internal bleeding and liver damage
What are the interactions between tylenol and alcohol?
liver and kidney disease
What are the interactions between sleeping pills and alcohol?
confusion, diarrhea
What are the interactions between anxiety and depression medications and alcohol?
more sensitive to alcohol effects, decrease in medication effectiveness
Are OA at in increased or decreased risk for adverse effects relating to medications?
increased
True or false. The process of drug metabolism is very different in OA compared to young adults.
true
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