-
liver metabolism phase I
cytochrome P450; oxidative pathway
-
phase II
conjugation pathway
-
water soluble drugs
have lower volume of distribution (lower volume of distribution=higher amt of drug)
-
fat soluble drugs
have increased volume of distribution (lower blood levels of drug)
-
protein bound drugs in elderly
- higher amt of free active drug
- digoxin, dilantin
-
elimination:
half-life in elderly...
clearance...
- half life =increased
- clearance= reduced
-
elimination:
effects of aging worse on renal or hepatic
renal function worse
-
elimination:
which is best measurement of clearance?
- creatinine clearance
- use cockroft gault equation
-
risk factors for ADR
- >6 DX's
- >12 doses of meds per day
- >9 meds
- prior ADR
- low BW/low BMI
- CrCl <50ml/min
-
EBP:
HTN
treat SBP >160 w/thiazide diuretic unless compelling indication
-
EBP:
DM
TZD's non-glycemic effects on BW, lipids, and BP
-
EBP:
psychotropics
haldol and risperdal have equal effect; no less likely to cz side effects
-
EBP:
antiplatelet
ASA not better than plavix in CAPRIE study
-
EBP:
Aricept
cholinesterase inhibitors in Alzheimer's dz appeared to be marginal at best
-
EBP:
NSAIDS
CHF, HTN crisis, renal toxicity/ARF hospitalized more for thess than GI effects
-
EBP:
COX-2
- renal effects, edema, HTN appear similar to traditional NSAIDS
- increased cardiac deaths r/t COX-2's
-
EBP:
incontinence
cholinesterase inhibitors and anticholinergics should not be used in combination
-
principles for prescribing
- generics
- half tabs
- components
- reduced dosing frequency
- alternate day dosing
- drug holiday
- extended release drugs (usually not necessary and often dangerous)
-
eval of falls
- HX incident
- review meds
- review acute and chronic problems
-
fall exam
- R/O head and neck injury
- vision
- mobility, gait, balance, TXR
- inspect lower extremities= joints, feet
- neuro exam= mental status, muscle strength, sensation, reflexes, cerebellar fxn, rhomberg
- CV exam, orthostatics, pulse
-
FUO:
community
- respiratory
- UTI
- abd sepsis
- TB
- endocarditis
- septic arthritis (gout more likely cz of single hot joint than this)
-
FUO:
inpatient
- UTI
- asp PNE
- IV line sepsis
- infected pressure ulcer
- PE
- meds
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