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What rx changes in older adult
- Pharmkinetics
- NOT dynamics (what drug does to body)
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Age-related changes
- Less % water body weight, lean muscle mass, blood flow & albumin
- Increased in body fat (lipophilic meds such as benzos means fat will store and half life will be longer)
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What are 4 highly protein (albumin) bounds meds
- Warfarin (99%
- Diazepam
- Valproic acid
- Phenytoin
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What is the caffeine half life and what kind of molecule is it
- 1.5-9 hours
- max 15 min in younger and 100 in older
- CYP450 1A2 substrate
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What meds to avoid in elderly
systemic antiicholinergic, urinary retention, constipation, visual dis, and hypotension
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What non-psych anticholinergic med do we not like to use
Oxybutynin for overactive bladder due to highest systemic anticholinergic
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What psych meds we do not like to use
TCAs and some SSRIs (Fluoxetine and Paroxetine)
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Citalopram not rec when, options?
- bradycardia, recent MI, uncomp HF, HYPOK/Mg
- or hepatic impairment
- and PPIs!!
- Do escitalopram (1/2 dose gives still therapeutic)
- only SSRI that has 0 drug to drug interaction
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Which is the only SSRI with 0 med to med interaction
Escitalopram
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How much does 1 unit of insulin reduce BG by
50 units
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Med to dc 80yo+ and no cardiac hx
- aspirin dc due to GIB
- used a primary prevention but dc!
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All PPIs are what
CYP450 2C19 inhibitors
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ABx meds high for what in elderly
- HYPERKalemia
- trimethoprim-sulfamethoxone
- (Bactrum)
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Dementia meds are associated with what
- cholinesterase inhibitors -->
- bradycardia, pacemaker, hip fx, syncope
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