NURS 209 NEW EXAM QUESTIONS AND CORRECT ANSWERS
(A+) 100% VERIFIED
Pharmacokinetics - ANSWER the effect of the body on the drug
Leading cause of injury in older adults? - ANSWER Falls!
- pts who fall are more likely to be admitted to long term care
- a hx of falls is a big predictor for future falls!!
Cataract Surgery: indications - ANSWER - must be 20/40 or worse,
- and sx like glare, halo, and photosensitivity
Cataract Surgery: complications - ANSWER infection, retinal detachment, corneal
edema
Cataract Treatment - ANSWER prevent w/ multivitamins, antioxidant foods, supplements
- Surgery (vision must be 20/40 or worse, and sx like glare, halo, and photosensitivity)
- Complication: infection, retinal detachment, corneal edema
Presbyopia - ANSWER Farsightedness due to aging
- poor accommodation
- hardening of the crystalline lens (nuclear sclerosis)
- atrophy
- decreased photoreceptors in the retna
,absorption, distribution, metabolism, and excretion
how is absorption different in geriatric patients - ANSWER -certain diseases and
medications can cause increased GI motility (absorbs less drug) or increase motility
(sits there and is over-absorbed)
- decreased perfusion of blood to GI system, decr peristalsis
- antacid and PPI drugs = increased gastric pH (more basic( which affects absorption of
other drugs
- GI tract atrophy = decreased surface area and villi for absorption
- fewer active transporters, which changes absorption
*speed of absorption is DECREASED, but total amount absorbed is the SAME as young*
How does distribution differ in geriatric pt - ANSWER - older pt's have more fat and less
lean mass = fatsoluble drugs have more volume over which to distribute = decreased
serum levels
old people have less total body water = hydrophilic drugs have less volume to distribute
over, which is causing increased serum level
old patients have decreased serum albumin levels = drugs that are bound to proteins
will have less to bind to = increased free-floating active drugs in the blood
How is metabolism different in geriatric pts - ANSWER - Phase 1 metabolism
(cytochrome P450) system is used to metabolize drugs, and decreases with age.
,The P450 system can be inhibited or activated by other drugs/food
- individuals can have genetic polymorphisms = fast ultra-metabolizers
- First pass/Phase 1 metabolism (activates the drug): decr by 1% per year
- Phase 2 (hepatic/conjunction) metabolism = for inactivating drugs mostly
How is excretion different in geriatric pts - ANSWER - aging = decreased RENAL
FUNCTION (decr is mass and perfusion of kidney)
- low creatinine is a less reliable indicator of poor renal function in adults bc they have
decr muscle mass
- increased half life for water soluble drugs
Creatinine Clearance Formula - ANSWER 1.2 (140-age) (weight in kg)
_____________________________________
Serum creatinine (umol/L)
(for women, replace 1.2 with 0.85)
Pharmacodynamics - ANSWER How the drug affects the body
How is the CARDIOVASCULAR system different in geriatric pts - ANSWER - decr
baroreceptors sensitivity (therefore = postural hypotension caused by
antihypertensives)
- decr sensitivity and number of beta-adrenoreceptors (therefore decr
, vasodilation/constriction when in need)
- more likely to have prolonged QT interval (risk of arrhythmia and even vfib/MI)
How does the RENAL system differ in geriatric pts - ANSWER incr risk of dehydration,
hypovolemia and electrolyte imbalances esp if given diuretics
worse kidney function/perfusion = diuretics dont reach the site of action on kidney very
well = may need a BIGGER diuretic dose
Geriatric pts have ___creased sensetivity to CNS drugs - ANSWER increased
7 Categories of Medication Problems - ANSWER - Medical condition that requires new
or additional drug therapy.
•
Patient taking unnecessary drug
given present condition.
•
Incorrect drug for patient's medical
condition.
•
Correct drug, dose too low.
•
Correct drug, dose too high.
•
Adverse drug reaction.
•
Patient not taking drug correctly.
(A+) 100% VERIFIED
Pharmacokinetics - ANSWER the effect of the body on the drug
Leading cause of injury in older adults? - ANSWER Falls!
- pts who fall are more likely to be admitted to long term care
- a hx of falls is a big predictor for future falls!!
Cataract Surgery: indications - ANSWER - must be 20/40 or worse,
- and sx like glare, halo, and photosensitivity
Cataract Surgery: complications - ANSWER infection, retinal detachment, corneal
edema
Cataract Treatment - ANSWER prevent w/ multivitamins, antioxidant foods, supplements
- Surgery (vision must be 20/40 or worse, and sx like glare, halo, and photosensitivity)
- Complication: infection, retinal detachment, corneal edema
Presbyopia - ANSWER Farsightedness due to aging
- poor accommodation
- hardening of the crystalline lens (nuclear sclerosis)
- atrophy
- decreased photoreceptors in the retna
,absorption, distribution, metabolism, and excretion
how is absorption different in geriatric patients - ANSWER -certain diseases and
medications can cause increased GI motility (absorbs less drug) or increase motility
(sits there and is over-absorbed)
- decreased perfusion of blood to GI system, decr peristalsis
- antacid and PPI drugs = increased gastric pH (more basic( which affects absorption of
other drugs
- GI tract atrophy = decreased surface area and villi for absorption
- fewer active transporters, which changes absorption
*speed of absorption is DECREASED, but total amount absorbed is the SAME as young*
How does distribution differ in geriatric pt - ANSWER - older pt's have more fat and less
lean mass = fatsoluble drugs have more volume over which to distribute = decreased
serum levels
old people have less total body water = hydrophilic drugs have less volume to distribute
over, which is causing increased serum level
old patients have decreased serum albumin levels = drugs that are bound to proteins
will have less to bind to = increased free-floating active drugs in the blood
How is metabolism different in geriatric pts - ANSWER - Phase 1 metabolism
(cytochrome P450) system is used to metabolize drugs, and decreases with age.
,The P450 system can be inhibited or activated by other drugs/food
- individuals can have genetic polymorphisms = fast ultra-metabolizers
- First pass/Phase 1 metabolism (activates the drug): decr by 1% per year
- Phase 2 (hepatic/conjunction) metabolism = for inactivating drugs mostly
How is excretion different in geriatric pts - ANSWER - aging = decreased RENAL
FUNCTION (decr is mass and perfusion of kidney)
- low creatinine is a less reliable indicator of poor renal function in adults bc they have
decr muscle mass
- increased half life for water soluble drugs
Creatinine Clearance Formula - ANSWER 1.2 (140-age) (weight in kg)
_____________________________________
Serum creatinine (umol/L)
(for women, replace 1.2 with 0.85)
Pharmacodynamics - ANSWER How the drug affects the body
How is the CARDIOVASCULAR system different in geriatric pts - ANSWER - decr
baroreceptors sensitivity (therefore = postural hypotension caused by
antihypertensives)
- decr sensitivity and number of beta-adrenoreceptors (therefore decr
, vasodilation/constriction when in need)
- more likely to have prolonged QT interval (risk of arrhythmia and even vfib/MI)
How does the RENAL system differ in geriatric pts - ANSWER incr risk of dehydration,
hypovolemia and electrolyte imbalances esp if given diuretics
worse kidney function/perfusion = diuretics dont reach the site of action on kidney very
well = may need a BIGGER diuretic dose
Geriatric pts have ___creased sensetivity to CNS drugs - ANSWER increased
7 Categories of Medication Problems - ANSWER - Medical condition that requires new
or additional drug therapy.
•
Patient taking unnecessary drug
given present condition.
•
Incorrect drug for patient's medical
condition.
•
Correct drug, dose too low.
•
Correct drug, dose too high.
•
Adverse drug reaction.
•
Patient not taking drug correctly.
