Term
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Definition
discrimination based on age, especially prejudice against the elderly
ageist beliefs:
old people shouldn't drive
people must retire at age 65
sex isn't important to women after menopause
things were too different when they were young. they can't relate to my problems |
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Term
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Definition
aging:
a process of gradual and spontaneous change, resulting in maturation through childhood, puberty, and young adulthood and then decline through middle and late age
senescence:
the process by which the capacity for cell division, growth, and function is lost over time, ultimately leading to an incompatibility with life |
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Term
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Definition
normal decline in function in relation to population norms may not be considered disease
the difference between aging and disease may be a matter of degrees of severity:
cognitive decline vs. dementia
glucose intolerance vs. diabetes |
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Term
| maximum lifespan vs. life expectancy |
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Definition
life expectancy:
a population based estimate of likelihood of living to a particular age
an indication of the degree to which an environment is benign or hazardous. this has increased dramatically in the past 100 years
maximum lifespan:
the oldest age of any person from a group. an indication of cellular decline. this has changed very little in the past 100 years |
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Term
| myth: the primary goal of drug therapy is to increase life span |
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Definition
| fact: the majority of older people are more interested in quality of life than in duration of life |
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Term
| myth: older people exhibit more noncompliance than younger people |
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Definition
| fact: in the absence of dementia or financial hardship, older people have better compliance than younger people |
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Term
| serious ADRs are more common in older people |
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Definition
~12% of all hospital admission among those > 65 years are due to ADRs
>50% of inpatient ADR related deaths occur in older people
reasons:
polypharmacy (!)
altered pharmacokinetics
altered pharamcodynamics
failure to recognize early signs of ADRs (confusion with "normal" aging) |
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Term
| pharmacokinetic principles |
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Definition
changes in older people with direct relevance to drug handling
decrease in total body mass
marked decrease in lean body mass
change in body composition:
decreased proportion of body water
increased proportion of body fat
small reduction in serum albumin
decrease in liver blood flow and size
decreased renal function |
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Term
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Definition
| dehydration is nearly ubiquitous in older patients admitted to nursing homes or hospital |
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Term
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Definition
subcutaneous absorption may be altered by gains or losses in SQ fat
lowered body fat = quicker absorption of insulin
increased body fat = slower absorption of insulin
GI absorption is altered (slowed or decreased) in elderly due to:
decreased salivary flow
decreased GI peristalsis
decreased gastric juice secretion (increased pH)
decreased splanchnic blood flow
exceptions exist:
levodopa absorption is increased due to decreased GI levels of dopa-decarboxylase in the gut |
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Term
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Definition
changes in distribution are due primarily to:
increase in total body fat
decrease in lean muscle mass
decreased total body water
fat soluble drugs tend to increase Vd, while water soluble drugs tend to decrease Vd with age
other influences include:
decreased cardiac output
increased peripheral vascular resistance
decreased serum albumin levels (increased free drug)
decreased plasma protein binding (fat soluble drugs are more likely to penetrate the BBB) = increased sedation and nausea |
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Term
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Definition
hepatic drug clearance overall declines with age
hepatic blood flow may be diminished due to vascular disease (40% decrease from age 50 to 80)
CYP450 content declines:
2E1 and 3A isoforms decline with age
1A2 and 2C isoforms stay relatively constant
phase I metabolism decreases with age; phase II metabolism doesn't really decrease with age |
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Term
common drugs with reduced hepatic metabolism in older people
KNOW THIS LIST |
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Definition
ANALGESICS:
ibuprofen
naproxen
morphine
meperidine
CARDIOVASCULAR:
amlodipine
nifedipine
propranolol
verapamil
diltiazem
PSYCHOACTIVE:
alprazolam
diazepam
trazodone
nortriptyline
imipramine
desipramine (less than other TCAs) |
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Term
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Definition
with age:
decreased renal plasma flow (dehydration)
decreased tubular clearance
decreased creatinine clearance
average clearances decline by ~50% between age 25 and 85, without change in serum creatinine
CrCl calculation based upon age
CrCl = [(140-age)(kg)]/(72 x SCr) |
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Term
| common drugs with reduced renal clearance in older people |
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Definition
ANTIBIOTICS:
ciprofloxacin
gentamycin
streptomycin
tobramycin
amikacin
CARDIOVASCULAR:
digoxin
enalapril
lisinopril
procainamide
DIURETICS:
furosemide
HCTZ
triamterene
OTHERS:
amantadine
cimetidine
ranitidine
lithium
methotrexate |
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Term
| pharmacodynamic principles |
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Definition
the same drug concentration at the receptor site may have different effects for people of different ages
example of pharmacodynamic changes in older people:
morphine - increased analgesic effect with aging
warfarin - increased INR with aging
albuterol - decreased bronchodilation with aging
diltiazem, verapamil, ACEi, ARB - increased BP reduction with aging
diazepam - a lot of increased sedation with aging
haloperidol - decreased sedation with aging
levodopa - increased dose related ADRs with aging
furosemide - decreased diuretic response with aging
sulfonylureas - decreased hypoglycemic response with aging |
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Term
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Definition
risks of interactions increase in a greater than linear relationship as the number of medications increase
top 10 drug interactions in older patients:
warfarin + NSAIDs = GI bleed, increased INR
warfarin + sulfa drugs = increased INR
warfarin + macrolides = increased INR
warfarin + quinolones = increased INR
warfarin + dilantin = increased INR, increased dilantin
ACEI + K supplements = increased K
ACEI + spironolactone = increased K
digoxin + amiodarone = increased digoxin levels
digoxin + verapamil = increased digoxin levels
theophylline + quinolones (not including levofloxacin) + increased theophylline levels |
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Term
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Definition
many interactions
decreased Vd due to decreased muscle mass
digoxin toxicity may be mistaken or unrecognized in elderly
cardiac disturbances may be more signnificant |
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Term
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Definition
SL absorption may be slowed due to decreased saliva production
venodilation effect is unaltered
hepatic metabolism is unaltered, unless marked liver size reduction is present
hepatic metabolism is reduced with interactions with ASA and alcohol |
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Term
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Definition
CNS distribution and retention may increase
hepatic metabolism may be reduced
normally very high first pass elimination
chronotropic effects may be reduced - pharmacodynamic response
clinical effects are unpredictable |
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Term
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Definition
free drug levels may be increased
pharmacodynamic effects may be blunted
reduced renal elimination with reduced kidney function
consequences of hypoglycemia may be more severe
extremely unpredictable |
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Term
| guideline application in the elderly |
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Definition
guidelines for HTN, heart disease, lipids, diabetes, and others may not apply in the very old
examples:
PRIMARY prevention of CAD with ASA is NOT supported after age 75
tight glycemic control may increase mortality in elderly people
hypoglycemia and fall risk |
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Definition
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