Pharm -9- Geri Pharm

Question Answer
If I am talking about what the body does to the drug like absorption, distribution, metabolism and clearance what am I likely talking about The pharmacokinetics of the drug
If I am talking about what the drug does to the body ie affecting trasmitters, receptors, second messengers then what am I talking about Pharmacodynamics of the drug
What areas of pharmacokinetics are changed with aging all of them affects absorption, distribution, metabolism, clearance/elimination
T/F absorption of drugs is greately affected by aging F no significant change with age gut affected by achlorhydria, prolonged transit time in gut and other drug interactions
Why is distribution affected with aging decreased water and lean muscle mass decreases distribution of hydrophilic drugs and increased fat % increases distribution of lipophilic drugs. THere can also be a change in the levels of transport proteins with age
T/F acetylation of drugs does not change with aging T
T/F oxidative metabolism by cytochrome -450 declines with aging decreasing ability to clear drugs T
T/F aging is the single greatest predictor alone of metabolism of drugs declining in the liver F- aging does play a role but is genetics, nutrition, environmental exposure and disease have a greater effect than aging alone
What are the metabolic characteristics of the ideal drug for an elderly pt undergoes phase II metabolism and does not compete for, induce or suppress its own metabolism
T/F serum creatinine tends to not change with aging showing that pts can eliminate drugs through the kidney just as easily in aging F serum creatinine tends not to change but remember you have decreased lean body mass creatinine levels remaining the same is falsely reassuring
What equation can you use to check kidney function and creatinine clearance Cockcroft-Gault Formula (ages 40-80)
What type of drugs are eliminated via the lungs volatile drugs
Why are volatile drugs avoided in the elderly they generally have decreased lung function and more likely to have active pulmonary disease which would reduce elimination of volatile drugs via the lungs
Why is it hard to establish pharmacodynamic changes in the elderly difficult to account for baseline differences, cultural and educational differences that can affect subject responses to a drug
Why do you see a pharmacodynamic shift in the CNS active drugs in the elderly altered neurotrasmitters/receptors, hormonal changes, impaired cerebral glucose metabolism, decreased oxygen and cerebrovascular changes, better CNS penetration with age (reduced glycoprotein activity
Elderly pts often have reduced P-glycoprotein activity that results in what regarding pharmacodynamics increased CNS penetration of drugs
What is the EC50 serum conenctration at which 50% of patients demonstarte an effect of a drug such as sedation
What happens to the EC50 of benzos in the elderly it is decreased by 50% in older adults IE it takes 50% lower concentration to have half of elderly pts to have s/e
What is the likely reason that EC50 is decreased in the elderly with benzodiazepine distribution to brain is increased in elderly adults probably from increased brain penetration of drug
T/F neuromuscular blocker need dose adjustment in the elderly due to increased sensitivity to the drug F sensitivity does not change but pharmacokinetics do
T/F opioids have both a change in sensitivity and kinetics in the elderly T
T/F the elderly are more sensitive to anesthetics T
T/F there is really no change in ACE-inhibitor pharmacodynamics with age T
What pharmacodynamic changes are seen in dihydrophyridines greater response in naive elderly
What changes are seen in the cardiovascualr drugs that are non dihydropyridines in the elderly Decreased sensitivity of PR response and enhanced HR and BP responses
How does Beta Adrenergics change in the elderly Beta sensitiviy decreases with age, with the exception of Beta blockers in elderly with very high blood pressure
Pts Creatinie Clerance is less than 30ml/min what would not be a good choice as a diuretics Hydrochlorothiazide
The change in response to diuretics by the elderly is largerly due to pharmacodynamic changes F most due to pharmacokinetic changes
What is one of the greatest predicotrs of anticoagulant response Age
If pt receives either an inappropriate drug or the wrong dose what has just occurred a drug error
what is an adverse drug event any drug related incident that results in harm to the patient
What are some common causes of serotonin syndrome (general causes not specific drugs) Too high a dose of meds, combining meds with similar effect on serotonin levels, some illicite drugs and herbal supplements can cause serotonin syndrome
What are the s/sx of serotonin syndrome Agitation, confusion, tachycardia, HA, diaphoresis and diarrhea
T/F opiates and opiate like drugs can cause serotonin syndrome T
T/F antiepileptics can cause serotonin syndrome T especially when combined with valproic acid
If pt has new pain symptoms and they are taking an antidepressant what caution should you exercise if you give an opiate go low and go slow until pain is managed
What is the tx for serotonin syndrome stop meds, hydrate pt, cool to counteract hyperpyrexia, benzos for agitation but best to prevent it
Which develops more rapidly serotonin syndrome or neuroleptic malginant syndrome Serotonin syndrome develops minutes to hours while NMS takes days to week
What are the s/sx of neuroleptic malignant syndrome muscle rigidity (lead Pipe), autonomic dysregulation, hyperthermia and altered mental status (even coma)
What is the tx for neuroleptic malignant syndrome stop culprit med, cool pt, support vital functions, mild benzo, moderate dopamine agonist (bromocriptine), severe dantrolene (for muscle rigidity)
If pt develops neuroleptic malignant syndrome what should you switch them to switch to atypical antipsychos
What is the difference between Serotonin Syndrome and Nueroleptic Malignant syndrome in medication cause Serotonin= Serotonergic drug NMS=dopamine agonist
What is the difference between Serotonin Syndrome and Nueroleptic Malignant syndrome in pupils Ser=mydriasis; NMS=normal
What is the difference between Serotonin Syndrome and Nueroleptic Malignant syndrome in bowel sounds Ser= hyperactive; NMS=normal or decreased
What is the difference between Serotonin Syndrome and Nueroleptic malignant syndrome in reflexes Ser=hyperreflexia; NMS=bradyreflexia
What is the difference between Serotonin Syndrome and Nueroleptic malignant syndrome in lab values Ser will rarely have elevated aminotransferases and rhabdo while these are common findings in NMS
What is an adverse drug event in parkinson's disease marked by fever, rigidity, autonomic instability, and risk of aspiration pneumonia Parkinsonism-hyperpyrexia syndrome from withdrawal/decrease of dopaminergic meds or amantadine and anticholinergics
What is the tx for parkinsonism-hyperpyrexia syndrome dopaminergics, supportive care +/- methylpredisolone
What is the tx for parkinsonian dyskinesia lower dose of dopaminergics, give mild benzo for dyskinesia
What is the tx for acute dystonic reaction stop precipitating med give anticholinergics benzotropine or diphenhydramine
T/F baclofen withdrawal is not not concerning and you can stop med without tapering False life threatening syndrome with rigidity, fever, change in menatl status, worsening dystonic symptom so taper withdrawal
What is the prescribing cascade tendency to prescribe a med to address a s/sx caused by another medication usually no appreciated
What are the mild s/e of anticholinergics dryness of mouth, dilation of pupils, urinary hesitancy, decreased sweating, drowsiness/fatigue, mild amnesia, inability to concentrate
What are the moderate s/e of anticholinergics thirst, vision disturbances, constipation, reduced gastric secretions/emptying, increased heart rate, excitement/restlessness, confusion and memory impairment

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