Geriatrics Part 1 HL Exam 4

ONLY HIGHLIGHTED QUESTIONS

Which of the four components of PK are affected by aging?

ADME (all in some way)

How is absorption affected by aging?

GI changes can delay absorption, but there is no major change in the amount absorbed

How do GI changes delay absorption?

weaker peristalsis, delayed gastric emptying

↓ skin perfusion

↓ saliva

Which injections should be avoided in elderly patients?

IM (unpredictable)

How is distribution affected by aging?

↓ lean muscle mass: ↑ blood levels

↑ body fat: ↑ Vd for lipophilic drugs which prolongs effects

↓ TBW: ↑ plasma concentrations of water-soluble drugs

↓ albumin: ↑ free (active) fraction of highly protein-bound drugs

KNOW THESE

How is metabolism affected by aging?

↓ liver mass

↓ hepatic blood flow (up to 50%)

↓ first-pass metabolism: ↑ bioavailability for high-extraction drugs

Phase I (Oxidative Metabolism) may ↓ #controversial though

Phase II (Metabolism) generally preserved unless patient is frail/malnourished

KNOW THESE

What are high extraction drugs?

morphine, propranolol, CCBs, TCAs, statins

How is elimination affected by aging?

↓ renal blood flow

↓ GFR

↓ tubular secretion

CrCl ↓ with age, but SCr may appear "normal"

Renally cleared drugs accumulate (i.e., digoxin, aminoglycosides)

Which PK component is most affected by aging?

elimination

What is the potential impact of achlorhydria on the absorption of medications?

↓ absorption of B12, Ca, Fe

In general, what is the result of pharmacodynamic (PD) changes of aging on drug therapy outcomes?

increases sensitivity to the effects of drugs

What are the 4 predictors of severe ADRs?

Specific medications

Number of medications taken

Age

Comorbidities

Which medications may cause severe ADRs?

diuretics, NSAIDs, antiplatelets, and digoxin

What is the most significant ADR occurring in older adults associated with poor prognosis and early mortality?

medication related falls

What are some results of medication related falls?

Premature institutionalization

Early death

What is a RF of medication related falls?

polypharmacy

What are common geriatric syndromes?

Immobility

Isolation

Incontinence

Infection

Inanition (malnutrition)

Impaction

Impaired senses

Instability

Intellectual impairment

Impotence

Immunodeficiency

Insomnia

Iatrogenesis

What are 2 diseases that present with atypical symptoms in elderly patients?

thyroid dysfxn and infection

present as delirium

What patients qualify for hospice care?

individuals who have less than or equal to 6 months life expectancy if the disease runs its typical course

Hospice care guidelines and regulations are primarily defined by federal regulations.

What are common disease states that require palliative care?

"life limiting diseases"

Cancer

COPD

Dementia (+ Alzheimer's + Parkinson's)

Chronic cardiac disease

Stroke

Renal failure

Hepatic failure

Multiorgan failure

DM

+ others