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Fall'20 Pharmacology III > Geriatrics > Flashcards

Flashcards in Geriatrics Deck (116)
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1

In the absence of specific information, it is generally prudent to do what when administering drugs to aged patients?

“Start low and go slow”

2

Aging has been described as a progress I’ve loss of...

Physiologic processes necessary to maintain homeostasis

Death being the ultimate failure of these mechanisms

3

In the elderly passive gastric absorption is

Not markedly altered

4

Drugs that inhibit intestinal motility have greater effect than

Age

5

Due to erratic absorption and a tendency to develop sterile infiltrates, IM and SQ injections are generally recommended or not in the elder patients?

Not!

6

Total Body water is decreased by what % in elderly?

10-15%

7

Due to decreased thirst, elder patient may be

Dehydrated

8

A decrease in TBW, in combination w/changes in the distribution of CO, results in a

Decreased central compartment volume

9

Initial plasma concentrations following rapid IV admin may be increased b/c of the decreased size of the central compartment, yet the steady state distribution vol is?.... and why?

May be larger d/t increased body fat

10

Body fat increases and muscle mass decreases in the elderly by what%?

How does this impact lipophillic drugs?

20-40%

So lipophillic drugs will have a large vol of distribution

11

Even in healthy and exercising elderly, what is lost?

Muscle mass

12

Failure to adjust for weight raises concern for this?

Over medication

13

Are plasma protein levels a major concern in geriatric pharmacology?

No - not been identified

14

Hepatic blood flow declines how much?

Liver mass reduces?

20-53% while liver mass is reduced 11-36%

15

Tell me about hepatic function of the elderly in regards to:

Endoplasmic reticulum
Hepatic extracellular space
Bile flow

Endoplasmic reticulum is diminished
Hepatic extracellular space increased
Bile flow decreased

16

What phase of liver metabolism is effected in the elderly? Why?

Phase I - which is catalyzed mainly by microsomal CYP450 enzymes may be decreased.

Enzyme activity is relatively preserved.

17

Are phase II reactions affected in old age?

Appears to be unaltered

18

Generally, age reduces clearance of flow-limited drugs by what ___%? Similar to the decrease in hepatic BF, but there’s is no alteration for _______ drugs.

30-40%

Capacity limited

19

How much does GFR decrease per yr?

1ml/yr

20

What’s the overall consensus generally about renal function and aging?

In the absence of disease

Although there is a small decrease in GFR, it probably decreases less than once thought.

Aging doesn’t appear to diminish renal drug excretion significantly

21

In the elderly what happens to CO?

With coexisting disease, what happens to circulation time?

CO is maintained.

With coexisting dx - circulation times appear to increase

22

Due to increased circulation times and the delay of initial drug effects, what is a prudent action to reduce overdose and adverse CV impact?

Slower bonus injections

23

Opioid elimination occurs mainly by

Hepatic metabolism with renal excretion of metabolites and some parent drugs

24

What factors influence opioid metabolism?

Genetics
Gender
Age
Environmental Factors
Current medications
Diet
Disease

25

Name three opioids with active metabolites:

Codeine, Morphine, Meperidine

26

The metabolites of some opioids that are active account many side effects as well as

Persistent analgesia

27

The primary risks of opioids with the elderly

Respiratory depression

The incidence is increased with age

28

Respiratory depression was more problematic with _____ vs meperidine.

What is seen in pts receiving fentanyl?

Morphine

And no resp depression in pts receiving fentanyl

29

Fentanyl is a highly selective:

Mu receptor agonist

30

Fentanyl is metabolized by

CYP3A4 to inactive and nontoxic metabolites