How may the absorption of medications change for pts >65?
- increased gastric pH
- decreased gastric emptying
- ” Ca++ absorp
- ” first pass effect
- increased bioavailability for beta blockers/opiates because fraction of meds aren’t loss as much as younger individuals
- inhibition of cytochrome P450 pathway
- increased bioavailability of some drugs(might get too much of drug cos they metabolize slower)
How can metabolism of meds changed for >65 yos?
- decreased blood flow to hepatic circulation
- decreases metabolism of the drug
- >half life, especially cardiac drugs
How can distribution of meds change for pts over 65?
- fluctuations in body water volume
- increase in body fat distribution
- lipophilic meds include opiates
How can excretion of meds change for pts >65?
- decrease
- creatinine clearance
- glomerular filtration rate
- drug clearance reductions
- amantadine (antiviral for flu)
- aminoglycosides (gentamycin)
- atenolol, captopril
- cimetidine - tagamet
- digoxin
- lithium
- vancomycin
- reduced renal mass = reduced nephron #
- renal blood flow down TF GFR down
What medications are underused?
- ACEI’s
- beta blockers
- anticoagulants
- bisphosphonates
What medications are inappropriate to use in Nursing homes?
- nitrofurantoin
- amiodarone
- disopyramide
- nifedipine
- ticlopidine
- cimetadine
- metoclopramide
- chlorpheniramine (anti-histamine)
- NSAID’s
- Fentanyl
- Methadone
- glyburide
- promethazine
What is the drug-disease interactions for anti-hypertensives?
syncope
What is the drug-disease interactions for anti-cholinergic?
- BPH
- constipation
- dementia
What is the drug-disease interactions for ASA?
Peptic ulcer disease
What is the drug-disease interactions for benzodiazepines?
- dementia
- falls
What is the drug-disease interactions for bupropion?
siezures
What is the drug-disease interactions for calcium channel blockers?
heart failure
What is the drug-disease interactions for steriods?
diabetes
What is the drug-disease interactions for opiates?
constipation
What are the side effects of Aricept (donepezil)?
- nausea
- diarrhea
- insomnia
- falls
- increased infection
What is Aricept (donepezil) used for and how can it negatively impact pts?
- dementia
- interacts neg w/ anticholinergics, antidepressants, and some antibiotics
What effect does digoxin have on elderly?
- antiarrhythmic
- risk of toxicity
- reduced drug clearance
What affect does amiodarone have on elderly?
- antiarrhythmic
- HR drop
- AVOID
Disopyramide effect on elderly?
- induce heart failure
- AVOID
Nifedipine effect on elderly?
- risk for hypotension
- AVOID
What class are Calcium Channel blockers?
- anti-hypertensives
- can cause heart failure
What effects can the anti-hypertensive Calcium Channel Blockers have on the elderly?
- syncope (fainting), dizziness
- decreases vasodilator therapy
- HIGH RISK
What is the diuretic furosemide (Lasix) effect on elderly?
- neurological issues
- dizziness
- hypotension
- HIGH RISK
What are some anticoagulants that effect elderly?
- Pradaxa
- Xorelto
- Warfarin (HIGH RISK)
