Chronic Aging Exam 2 Outline
1.) What are geriatric Syndromes ?
Falls and gait abnormalities
Pressure ulcers
Delirium
Urinary incontinence
Sleep disorders
problems.
11.) Pharmacokinetics is?
Movement of a drug throughout the body from the point of administration as
it is absorbed distributed, metabolized and excreted
11aa.) What are the age related changes that occur in the
pharmacokinetics of the older adult?
Absorption is increased
Delayed stomach emptying
Changes in gastrointestinal motility
Drug to drug interaction
Drug to food interactions
Distribution
Reduce serum albumin levels , decreased lean body mass, increased
body fat, decreased total body water
Excretion
Significant decline in kidney function
Decreased glomerular filtration rate
Decreased creatinine clearance
Metabolism
• Unpredictable rate of metabolism
• Reduced liver activity mass , volume and blood flow
• Decreased hepatic clearance
11a.) Absorption is?
Delivery of a drug to the blood stream it is the amount of time
between the administration of the drug and its absorption depends
on
a number of factors
Route; bioavailability dose
11b.) How does physiological changes that can alter absorption?
Increase gastric ph
Delayed gastric stomach motility and emptying reduced bicar and
gastric mucus
Reduced function of intestinal villi and reduced ability to absorb
drugs
(intestinal motility is increased for any reason the effect of the drug
is diminished )
, 11c.) Distribution of a drug ?
After absorption drug is transported to the receptor site on a target
organ to have the desired effect
Depends on availability of plasma protein in the form of lipoproteins
, globulins and albumin.
They bind to protein they are distributed throughout the body
11e.) What is Metabolism ?
oIt is the process by which the body modifies the chemical structure of
the drug
oStay active long as it is in its active state
oLIVER IS the primary site of drug metabolism
11G.) Excretion is ?
Excretion is done thru the kidneys
Excreted in sweat, salvia and other secretions
Eliminating drugs from the body
11H.) Age related physiological changes that can affect metabolism?
Kidney function declines
Increase serum creatinine
Decrease creatinine clearance
Decreased GFR
Ability to excrete or eliminate drugs in a timely manner decline
11I.) What Is pharmacodynamics?
Refers to the interaction between a drug and the body
Example: Older the person becomes the more likely there will be an
altered or unreliable response of the body to the drug. Aging process
causes a decrease in Beta adrenergic receptor stimulators
Increased sensitivity to anticholinergics , benzodiazepines, narcotic
analgesics, warfarin, and the cardiac drugs diltiazem and verapamil
11J) What is Chrono pharmacology?
Relationship between the biological rhythms of the body and variations in
pharmacokinetics and pharmacodynamics
11K.) What is polypharmacy?
Five or more medications in se of the multiple medications for the
same problem
Increased risk for drug interaction
Increased risk for adverse events
, Can result from fragmented communication
11L.) Drug interactions:
Alternations in the absorption, distribution, metabolism, or execration, of
one or any of those medications
Two or more medications or food are taken together or close together
they may cause a change in the effectiveness of the other
Effects may be increased, decreased, or variable
Polypharmacy increases the risk for and frequency of medication and
medication interactions
11m.) Drug herb interactions:
Herbs can increase the risk of interactions w/ medications
NO Four GS
Garlic, gingko, ginseng, green tea, and echinacea
12.) Drug and food interactions Fiber and Digoxin interaction?
Absorption of drug into fiber reducing drug reaction
13.) Drug and food interaction with vitamin k; Warfain?
Decreased effect of the drug
NO: Kale, spinach, collards, swiss chard, mustard green, turnip greens,
parlsey, broccoli , and brussels sprouts
12b.) Any food and many antibotics interaction?
Reduced absorption rate of drug
12c.) Vitamin B6 supplements and levodopa carbidopa interaction?
Reversed antiparkinsonian effect
12d.) Grapefruit Juice and Multiple medications interaction?
Altered metabolism and elimination can increase concentration of drug
12E.) Citrus juice and calcium channel blockers medication interaction?
Gastric reflux exacerbated
13.) List three possible drug to drug interactions ?
ACE inhibitors and potassium sparing diuretics
Ace inhibitors or ARBS And Septra Bactrim
Macrolide antibiotics Cipro and either calcium channel blockers or digoxin
Warfarin and any of the antibiotics or NSAIDS
14.) What are adverse Drug Reactions ?
Level of harm
, Unwanted pharmacologic effect
Range from minor annoyances to unwanted pharmacological effects and
death
Common in those older than 65 years of age
Commonly observed adverse reactions in older adults include drug
induced delirium , confusion, and lethargy
15.) Medications that can easily impair cognitive function in older adults?
Analgesics , anticholinergics, antihistamines, benzodiazepines, antiparkinsonian
medications, beta blockers, and Lanoxin
16.) What are forms of misuse in drugs?
Overuse, underuse, erratic use, and contraindicated use
Examples: misunderstanding or inability to read labels or understand
instructions
Make medication last longer for financial reasons
Believe the dose is either too low or high
Forget to take the medication correctly
17.) Beer Criteria is?
Analysis of medication frequently prescribed to older adults
Potential for harm is greater than their potential benefits
1.) Potentially inappropriate for use with all older adults 2.) potentially
inappropriate for older adults with certain conditions 3.) should only be used
with caution 4.) should be avoided or have their dose changed for people with
impaired renal function 5 .) are on a list of drug- drug interactions
documented to be especially harmful to older adults
17a.) What are some potentially inappropriate medications for Beers
criteria?
Sliding scale insulin
Proton pump inhibitors for longer than 8 weeks
Digoxin
Benzodiazepines
Tricyclic and antidepressants
Medications with anticholinergic properties
Antispasmodics
sulfonylureas
18.) What are some psychoactive medications ?
Antidepressants, antianxiety agents, mood stabilizers, and antipsychotics,
and sedative hypnotics
Have a high risk of adverse events
Alter brain chemistry, emotions and behaviors
18a.) Antidepressants side effects and medications ? Slide 17
1.) What are geriatric Syndromes ?
Falls and gait abnormalities
Pressure ulcers
Delirium
Urinary incontinence
Sleep disorders
problems.
11.) Pharmacokinetics is?
Movement of a drug throughout the body from the point of administration as
it is absorbed distributed, metabolized and excreted
11aa.) What are the age related changes that occur in the
pharmacokinetics of the older adult?
Absorption is increased
Delayed stomach emptying
Changes in gastrointestinal motility
Drug to drug interaction
Drug to food interactions
Distribution
Reduce serum albumin levels , decreased lean body mass, increased
body fat, decreased total body water
Excretion
Significant decline in kidney function
Decreased glomerular filtration rate
Decreased creatinine clearance
Metabolism
• Unpredictable rate of metabolism
• Reduced liver activity mass , volume and blood flow
• Decreased hepatic clearance
11a.) Absorption is?
Delivery of a drug to the blood stream it is the amount of time
between the administration of the drug and its absorption depends
on
a number of factors
Route; bioavailability dose
11b.) How does physiological changes that can alter absorption?
Increase gastric ph
Delayed gastric stomach motility and emptying reduced bicar and
gastric mucus
Reduced function of intestinal villi and reduced ability to absorb
drugs
(intestinal motility is increased for any reason the effect of the drug
is diminished )
, 11c.) Distribution of a drug ?
After absorption drug is transported to the receptor site on a target
organ to have the desired effect
Depends on availability of plasma protein in the form of lipoproteins
, globulins and albumin.
They bind to protein they are distributed throughout the body
11e.) What is Metabolism ?
oIt is the process by which the body modifies the chemical structure of
the drug
oStay active long as it is in its active state
oLIVER IS the primary site of drug metabolism
11G.) Excretion is ?
Excretion is done thru the kidneys
Excreted in sweat, salvia and other secretions
Eliminating drugs from the body
11H.) Age related physiological changes that can affect metabolism?
Kidney function declines
Increase serum creatinine
Decrease creatinine clearance
Decreased GFR
Ability to excrete or eliminate drugs in a timely manner decline
11I.) What Is pharmacodynamics?
Refers to the interaction between a drug and the body
Example: Older the person becomes the more likely there will be an
altered or unreliable response of the body to the drug. Aging process
causes a decrease in Beta adrenergic receptor stimulators
Increased sensitivity to anticholinergics , benzodiazepines, narcotic
analgesics, warfarin, and the cardiac drugs diltiazem and verapamil
11J) What is Chrono pharmacology?
Relationship between the biological rhythms of the body and variations in
pharmacokinetics and pharmacodynamics
11K.) What is polypharmacy?
Five or more medications in se of the multiple medications for the
same problem
Increased risk for drug interaction
Increased risk for adverse events
, Can result from fragmented communication
11L.) Drug interactions:
Alternations in the absorption, distribution, metabolism, or execration, of
one or any of those medications
Two or more medications or food are taken together or close together
they may cause a change in the effectiveness of the other
Effects may be increased, decreased, or variable
Polypharmacy increases the risk for and frequency of medication and
medication interactions
11m.) Drug herb interactions:
Herbs can increase the risk of interactions w/ medications
NO Four GS
Garlic, gingko, ginseng, green tea, and echinacea
12.) Drug and food interactions Fiber and Digoxin interaction?
Absorption of drug into fiber reducing drug reaction
13.) Drug and food interaction with vitamin k; Warfain?
Decreased effect of the drug
NO: Kale, spinach, collards, swiss chard, mustard green, turnip greens,
parlsey, broccoli , and brussels sprouts
12b.) Any food and many antibotics interaction?
Reduced absorption rate of drug
12c.) Vitamin B6 supplements and levodopa carbidopa interaction?
Reversed antiparkinsonian effect
12d.) Grapefruit Juice and Multiple medications interaction?
Altered metabolism and elimination can increase concentration of drug
12E.) Citrus juice and calcium channel blockers medication interaction?
Gastric reflux exacerbated
13.) List three possible drug to drug interactions ?
ACE inhibitors and potassium sparing diuretics
Ace inhibitors or ARBS And Septra Bactrim
Macrolide antibiotics Cipro and either calcium channel blockers or digoxin
Warfarin and any of the antibiotics or NSAIDS
14.) What are adverse Drug Reactions ?
Level of harm
, Unwanted pharmacologic effect
Range from minor annoyances to unwanted pharmacological effects and
death
Common in those older than 65 years of age
Commonly observed adverse reactions in older adults include drug
induced delirium , confusion, and lethargy
15.) Medications that can easily impair cognitive function in older adults?
Analgesics , anticholinergics, antihistamines, benzodiazepines, antiparkinsonian
medications, beta blockers, and Lanoxin
16.) What are forms of misuse in drugs?
Overuse, underuse, erratic use, and contraindicated use
Examples: misunderstanding or inability to read labels or understand
instructions
Make medication last longer for financial reasons
Believe the dose is either too low or high
Forget to take the medication correctly
17.) Beer Criteria is?
Analysis of medication frequently prescribed to older adults
Potential for harm is greater than their potential benefits
1.) Potentially inappropriate for use with all older adults 2.) potentially
inappropriate for older adults with certain conditions 3.) should only be used
with caution 4.) should be avoided or have their dose changed for people with
impaired renal function 5 .) are on a list of drug- drug interactions
documented to be especially harmful to older adults
17a.) What are some potentially inappropriate medications for Beers
criteria?
Sliding scale insulin
Proton pump inhibitors for longer than 8 weeks
Digoxin
Benzodiazepines
Tricyclic and antidepressants
Medications with anticholinergic properties
Antispasmodics
sulfonylureas
18.) What are some psychoactive medications ?
Antidepressants, antianxiety agents, mood stabilizers, and antipsychotics,
and sedative hypnotics
Have a high risk of adverse events
Alter brain chemistry, emotions and behaviors
18a.) Antidepressants side effects and medications ? Slide 17
