Geriatric Optometry MT II - Pharm aspects of aging
Geriatric Optometry MT II - Pharm aspects of aging
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 Quiz!
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Noncompliance ranges from __ to __% |
21, 55 |
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Most common adverse drug events due to? |
- NSAIDs |
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T/F - Drug absorption is decreased with age. |
False - little effect with age |
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T/F - Most drug absorption is active. |
False - passive, dependent on drug conc |
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T/F - Active drug absorption less absorbed in older adults. |
True |
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What drugs/supplements are less actively absorbed? |
Calcium, organic calcium, certain vitamins (i.e. Vitamin D) |
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Distribution of drugs in the body is dependent on... |
body composition, plasma protein binding, blood flow to organs |
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T/F - Age leads to less water and fat. |
True |
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(Fat/Water) soluble drugs have incr distribution, and (fat/water) soluble drugs are distributed less. |
Fat, water |
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Barbituates (phenobarbital) and benzodiazapines (diazepam) are (fat/water) soluble drugs. |
Fat |
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Ethanol, digoxin, and cimetidine are (fat/water) soluble drugs |
water |
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T/F - Pharmaceutically active drugs are not bound to albumin |
True |
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Age reduces albumin by __%. What is the significance of this? |
25%; more drug in system, thus intense clinical effect and greater risk of adverse effects |
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The reduction of albumin with age is significant in which drugs mentioned? |
Warfarin, phenytoin |
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T/F - Hepatic blood flow decreases w/ age. |
True |
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T/F - Smoking does not affect the metabolism of drugs. |
False - affects metabolism |
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T/F - Drugs do not break down as fast and stay in the body longer in the elderly. |
True |
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How does drug elimination relate to the kidneys in the elderly? |
Decr renal blood flow and GFR so decr drug elimination |
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What is the significance of creatinine? Does it decr, remain stable, or incr w/ age? |
Meas renal drug elimination. Decr. |
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Monitor creatinine in pts taking these drugs... |
Digoxin, Chlorpropamide, Cimetidine, Lithium |
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What effect does cigarette smoking have on metabolism? |
Induces hepatic microsomal enzyme activity but effect on drug metabolism is variable. |
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The majority of hospital admissions in elderly is due to what type of disease? |
Cardiovascular |
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T/F - HTN, especially diastolic pressure increases after age 50. |
False - systolic |
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What impact does thiazide diuretics show on pts with renal impairment? |
Decreased natriuretic effect, esp when creatinine clearance below 20 ml/min - may lead to decr cardiac output and electrolyte imbalance |
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What drug class incr risk of hypokalemia? |
Diuretics (thiazide diuretics?) |
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Diuretic vision effects? |
Sudden onset myopia or changes in refraction |
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Digoxin (cardiac glycoside) half life elimination is (incr/decr) in older adults? |
incr |
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What cardiovascular drug class has a narrow dosage level difference between therapeutic and toxic levels? |
cardiac glycosides e.g. digoxin |
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What drugs enhances digoxin effects? |
Diuretics and certain Ca-channel blockers e.g. verapamil |
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Cardiac glycosides can cause what kinds of side effects? |
GI, cardiac, neuro, and visual disturbances (altered color vision - greens) Toxicity = nausea, anorexia, fatigue, depression |
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T/F - Beta blockers are effective heart meds for the elderly. |
False - decreased clinical response due to reduced interaction w/ cell receptors; also higher side effects (depression, confusion, incr falls) |
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Pts taking Ca-channel blockers and ACE inhibitors must be monitored for dosage and freq if they have what condition(s)? |
Renal, hepatic insufficiency ACE inhibitors - acute renal failure, hypotension, hyperkalemia |
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With ACE inhibitors, you must monitor pts with (hypo/hyper)kalemia. |
hyper |
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What significance do NSAIDs have with elderly? |
Interfere w/ prostaglandin synthesis, which also protects gastric mucosa and autoreg of renal blood flow. Signif incidence of GI dz and renal impairment in older pts. |
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Tylenol is effective if the pt has no Hx of... |
hepatic dysfxn, alcohol abuse |
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In what manner should NSAIDs be dosed? |
lowest dose, then incr slowly |
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CNS drugs have a (enhanced/decreased) effect in older adults. |
enhanced |
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Short half life in CNS drugs result in (more/less) falls. |
less |
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Barbituates and benzodiazepines have (incr/decr) half life in elderly. |
incr |
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What benzodiazepines are better alternatives for elderly? Why? |
Alprazolam, Lorazepam, and Tempazepam ("ALT") better since shorter half life. |
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Desipramine and Trazodone are what kind of drug? |
Antidepressants |
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When drugs are bound to albumin, they (can/cannot) pass the blood-brain barrier. |
cannot |
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T/F - H1-blocking agents can cross the blood brain barrier (why/why not?). |
True - since highly lipophilic |
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T/F - H1-blocking agents can have both depressive or stimulating effects. |
True - but mostly depressive in older pts |
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Most common side effect of H1-blocking agents? |
sedation |
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Older adults are (less/more) sensitive to the cognitive effects of H1-blocking agents? |
more |
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H1-blocking agents are best dosed when? |
QHS |
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Name two H1-blocking agents. |
Diphenhydramine (benadryl) and chlorpheniramine OTC. |
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What is the advantage of 2nd generation H1-blocking agents? |
Do not cross blood-brain barrier thus less side effect of CNS depression |
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H1-blocking agents can be Rxed with Pseudophedrine, but what ADEs should you watch for? |
Palpitations, HAs, insomnia in older adults |
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H2-blocking agents are used for... |
peptic and duodenal disorders |
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H2-blocking agents ADEs? |
Safe but HAs and mental confusion possible |
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H2-blocking agents have contraindication with what drugs? |
Cimetidine (inhibitor of P450), drugs metabolized by P450 e.g. benzodiazepines, phenytoin, theophylline, warfarin |
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Name the anticholinergic drug classes mentioned |
Hypnotics and Anti...psychotics, depressants, epileptics, spasmodics, histamines |
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Anticholinergic drugs and elderly don't mix well because... |
Elderly more susceptible to impaired autonomic effects on GI, bladder, CNS; loss of memory and delirium w/ atropine; sudden loss of memory w/ scopolamine |
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(Incr/Decr) mortality rates w/ antimicrobials in the elderly due to... |
Incr due to reduced host-defense mech and rxn to antimicrobials |
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(Narrow/Broad) antibiotics are preferred in elderly. |
Broad |
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Watch for decr renal fxn in these antibiotics... |
Fluoroquinolones, amantadine, tetracyclines (except doxy and minocycline) |
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What consideration should you take in elderly pts w/ CHF or renal failure taking antacids? |
Sodium content in antacids - watch for pts w/ CHF and renal failure |
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In elderly, antacids alters pH, (incr/decr) acidic drug absorption, and (incr/decr) basic drug absorption. |
incr, decr |
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Alcohol (in consideration of cold/cough meds) can... |
potentiate effects of antipsychotics, sedatives, and H1 antihistamines |
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Older pts w/ what kinds of problems are advised against the used of antihistamines or anticholinergic agents? |
Asthma, glaucoma, urinary tract probs |
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Long term use of laxatives can cause... |
disturbances in electrolyte and water balance |
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What types of laxatives are safest for chronic constipation? |
Bulk formers, stool softeners |
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Megadose vitamin intake is assoc w/... |
renal and CNS effects |
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Niacin side effects... |
Alter liver fxn and raise uric acid and glucose in blood |
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What vitamins affect lab tests? |
Vit A and D |
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Alcohol + CNS depressants = what ADE(s)? |
Enhanced depression |
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Alcohol + Phenothiazines = what ADE(s)? |
Inhibition of phenothiazine absorption |
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Alcohol + Aspirin = what ADE(s)? |
GI bleeding |
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Alcohol + Tetracycline = what ADE(s)? |
Divalent cations prevent absorption of drug |
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Topical Alpha-2 adrenergic ADEs? |
oral dryness, fatigue, ocular allergic rxn |
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Topical nonselective adrenergic blockers (i.e. timolol) ADEs? |
bronchial, cardio, CNS effects e.g. fatigue, depression, confusion |
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Adrenergic agonists ADEs? |
Dry upper respiratory passage, HAs, anxiety, tachycardia, hypertensive crisis |
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T/F - Phenyl only causes tachycardia. |
False - can also cause reflex bradycardia |
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What adrenergic agonist causes subarachnoid hemorrhages and occipital HAs? |
Phenyl |
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T/F - Adrenergic-blocking agents causes constipation. |
False - diarrhea |
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Name two cholinergic agonists. |
Pilo, echothiophate |
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T/F - Pilo can cause GI disturbances. |
True |
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T/F - Echothiophate can cause dryness of the mouth. |
False - salivation |
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T/F - Atropine causes excessive urination. |
False - urinary retention (cholinergic antagonist!) |
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T/F - Atropine decreases the heart rate. |
False - tachycardia |
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T/F - Cyclopentolate causes drowsiness. |
True - also restlessness! |
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T/F - Cyclopentolate causes restlessness |
True - also drowsiness! |
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T/F - Cyclopentolate causes incoherent speech. |
True |
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T/F - Local anesthetics cause bradycardia. |
False - tachycardia |
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T/F - Local anesthetics cause nervousness. |
True |
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T/F - Local anesthetics cause hypotension. |
True - and hypertension too!!! |
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T/F - Topical adrenergic-blocking agents can cause asthma. |
True |
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T/F - Sulfonamides causes contact dermatitis. |
False - Exfoliate dermatitis Neomycin = contact dermatitis |
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T/F - Chloramphenicol causes erythema multiforme. |
False Sulfonamides = erythema multiforme |
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What is a cheap alternative to tobradex? |
Maxitrol |
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What is a cheap alternative to Vigamox/Zymar? |
Oculflox/Ciloxin |
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What is a cheap alternative to Pataday? |
Zatidor |
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RDA for elderly in older... |
2300 kcal |
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High protein diets are (more/same/less) digested and absorbed in elderly. |
less |
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__g/kg of protein meets the need for elderly. |
1 |
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Carb absorption in elderly (incr/same/decr)? |
decr (slightly impaired) |
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How does fat absorption compare in elderly vs younger? |
Equivalent up to 100g, but >120g/day less fat abs; institutionalized even less b/c body doesn't need to store it - don't move that much |
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T/F - Elderly typically have good vitamin status. |
False - inadequate vitamin status common; poor food choices, inadequate dietary intake |
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Vit A adequacy in elderly? Physiological change? |
may be too high; increased absorption |
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Vit D adequacy in elderly? Physiological change? |
too low; decr skin synthesis, decr absorption |
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Thiamine adequacy in elderly? |
adequate |
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Riboflavin adequacy in elderly? |
adequate |
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Vit B6 adequacy in elderly? Physiological change? |
too low; serum homocysteine levels rise when too low |
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Folate adequacy in elderly? |
may be too low |
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Vit B12 adequacy in elderly? |
may be too low |
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Ascorbate adequacy in elderly? |
adequate |
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Calcium adequacy in elderly? |
too low |
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Iron adequacy in elderly? |
adequate |
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Zinc adequacy in elderly? |
adequate |
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Copper adequacy in elderly? |
adequate |
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Selenium adequacy in elderly? |
adequate |
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Magnesium adequacy in elderly? |
too high |
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Chromium adequacy in elderly? |
too high |
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What supplement type is the standard of care for ARMD? |
antioxidants |
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*Undernutrition is defined as... |
- Lose >10lbs in 6 mo |
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AREDS supplement regimen? |
Vit C 500mg |
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AREDS supplements decreased ARMD by __% |
25 |
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Free radical effect on carbohydrates? |
breaks chains of hyaluronic acid |
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Free radical effect on nucleic acids? |
genetic defects |
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Free radical effect on proteins? |
fragments plasma proteins, decr body fxns |
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Free radical effect on lipids? |
cellular membrane function destruction (remember elderly tend to have leaner bodies) |
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How does Vit E in the skin protect vs free radicals? |
prevents cell wall damage by reacting w/ free radicals |
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What role does bilirubin and uric acid play in protecting the body? |
scavenge oxyradicals |
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What role do plasma proteins play in protecting the body? |
reduce formation of atheromas on BV walls |
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Free radicals result in lens (hydration/dehydration)? |
dehydration |
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This harmful behavior diminishes levels of antioxidants, ascorbate, and carotenoids. |
Smoking |
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Hyperbaric chambers cause... |
Reduced glutathione, incr glutathione sulfide |
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T/F - There is a reduced size and frequency of B cell mediated response in the elderly. |
False - true for T-cells! No change for B-cells. |
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How are phagocytosis and the ability to fight cancer in the elderly related? |
Antigen processing delayed |
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What mineral is essential for cell mediated immunity? |
Zinc |
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What mineral is essential for lymphocytic and granulocyte fxn? |
Iron |
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Supplements of Vit C and Zinc in elderly increase ___ and ___ (immune responders). |
T-cells and IgG |
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T/F - Obesity is a risk factor for diabetic retinopathy. |
True |
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What antioxidant is excluded from the nutritional intervention of cataracts? |
Vitamin A |
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T/F - HTN is a risk factor for ARMD. |
True |
