Pharmacokinetics Geriatrics 3

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Pharmacokinetics Geriatrics 3
2013-12-08 22:52:02
Pharmacokinetics Geriatrics
Pharmacokinetics Geriatrics 3
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  1. Do Elderly patients have less or more creatinine?
    Less, dut o less muscle mass
  2. What is the CrCl in most elderly adults?
    50-80 ml/min
  3. What is the average CrCl of a nursing home patient?
    40 ml/min
  4. What equation for CrCl is used for elderly adults?
  5. Should you round up to 1 ml/min SCr in elderly?
  6. What is more accurate for elderly adults than CrCl?
  7. What is the decline in GFR from 20-90 years?
  8. Do most package inserts have GFR/dose info?
  9. For medications primarily eliminated by the kidney, what dose adjustment would you expect for an elderly adult with a CrCl of 30-60?
  10. For medications primarily eliminated by the kidney, what dose adjustment would you expect for an elderly adult with a CrCl of 15-30?
  11. For medications primarily eliminated by the kidney, what dose adjustment would you expect for an elderly adult with a CrCl of <15?
  12. Do flouroquinolones need to be adjusted for altered CrCl?
  13. Are antivirals renaly eliminated?
  14. Do H2 antagonists need renal dose adjustments?
  15. Do you need to dose adjust Famotidine in elderly with reduced CrCl?
    Not usually unless very low
  16. Are non-steroidal anti-inflammatories a good choice for older patients?
  17. Is fluconazole safe in older adults with reduced renal function?
    Not usually
  18. What special needs do older patients have for Digoxin treatments?
    Need renal adjustments as they age (most likely will be on it long term)
  19. What renally eliminated active metabolites need to be considered in elderly patients with reduced renal function?
    Morphine active metabolites, Mepereidine metabolites can cause seizures, Carbamazeptine has an active metabolite
  20. Are older adults less or more sensitive to drug therapies?
  21. How should you deal with sensitivity increase in elderly adults?
    Start low and go slow
  22. What are some of the possible mechanisms for increased drug sensitivity in older adults?
    Changes in number and affinity or receptors, changes in post-receptor alterations, age related impairment of homeostatic mechanisms
  23. Why should you evaluate older adults for BP when both sitting and standing?
    To check for orthostatic hypotension
  24. Are elderly less sensitive to Beta agonists or antagonists?
  25. What changes in effects of CCBs occur with age?
    Increase hypotensive and HR response to CCBs
  26. Are older adults are more or less at risk for developing drug induced QT prolongation/torsades de pointes?
  27. Care there an increased number Cholinergic neurons in the brains of elderly?
  28. What changes in acetylcholinesterase occur in older adults?
  29. What changes in dopamine type 2 receptors occurs in elderly patients?
  30. What changes occur in dopamine and dopaminergic neurons in the substantis nigra of elderly patients?
  31. What is the outcome of CNS changes in elderly adults?
    Alcohol response increase, Increase CNS response to benzodiazepines, Increased analgesic response to opioids, More susceptible to delirium and extraparameteral side effects
  32. What changes in response to acetylcholine blockers in elderly may occur?
    Cause mental confusion, memory impairment and delirium, constipation, BPH, incontinence and glaucoma
  33. You should promote or avoid medications in elderly with anticholinergic side effects?
    Avoid, may cause delirium, etc.
  34. What changes in fluid and electrolytes occur with age?
    Dehydration, hyponatermia, hyperkameia and prernal azotemia, especially with diuretics
  35. Does Glucose tolerance increase or decrease with age?
  36. What changes in response to Anticoagulants occurs in older adults?
    Greater inhibition of Vitamin K dependent clotting factors on warfarin