Geriatric syndromes

  1. What are the age related changes in physiology that affect pharmacokinetics?
    • Body composition:
    • decreased body water = decreased Vd H2O soluble
    • increased body fat = increased Vd fat soluble
    • GI:
    • increased gastric pH = decreased absorption of basic drugs
    • delayed gastric emptying
    • slowed intestinal transit
    • Liver:
    • decreased size
    • decreased hepatic blood flow
    • decreased clearance, increased half-life
    • Renal:
    • decreased GFR
    • decreased renal blood flow
    • decreased tubular secretory function
    • decreased clearance, increased half-life
  2. What are the types of urinary incontinence?
    • Urethral underactivity (stress urinary incontinence)
    • Bladder overactivity (Urge urinary incontinence)
    • Urethral overactivity and/or bladder underactivity (overflow incontinence)
    • Mixed incontinence (stress and urge incontinence combination)
  3. What are the sx of urethral underactivity (stress urinary incontinence)?
    • leakage of small amounts of urine during exertional activities
    • Frequency and urgency may be present
    • mostly WOMEN
  4. What are the sx of bladder overactivity (urge incontinence)?
    • urinary frequency (>8 times/d)
    • with or without urgency
    • nocturia and/or nocturnal enuresis
    • loss of larger urine volumes than stress incontinence
  5. What are the sx of overflow incontinence?
    • straining to void
    • dribbling
    • frequency
    • urgency
    • BPH
    • mostly MEN
  6. What drugs are used for stress incontinence?
    • Duloxetine (DOC)
    • alpha-Adrenergic agonists (pseudoephedrine)(2nd line)
    • Topical estrogen (pts with urethritis or vaginitis)
    • Imipramine
  7. What drugs are used for urge incontinence?
    • Anticholinergics/antispasmodics (oxybutunin or tolterodine are DOC)
    • TCAs (for depressed pts)
    • topical estrogens (pts with urethritis or vaginitis)
  8. What drugs are used for overflow incontinence?
    • alpha-1 blockers
    • 5-alpah reductase inhibitors
  9. What is the MOA of anticholinergics/antispasmodics in urinary incontinence?
    nonselective muscarinic antagonism
  10. What are the SE of anticholinergics/antispasmodics?
    • dry mouth
    • blurred vision
    • constipation
    • tachycardia
    • urinary retention
    • dizziness
    • confusion
    • cognitive dysfunction
    • sedation
    • erythema (patch)
    • pruritis (patch)
  11. Which anticholinergic formulation causes the most SE?
    immediate release
  12. Which anticholinergic formulations cause the least SE?
    • extended release
    • transdermal patch
  13. What is the MOA of alpha-1 blockers in BPH or overflow incontinence?
    • bladder neck and prostate smooth muscle relaxation
    • peripheral smooth muscle relaxation
  14. What are the SE of alpha-1 blockers?
    • first-dose syncope
    • OH
    • dizziness
    • Intraoperative floppy iris syndrome (IFIS)
  15. When are alpha-1 blockers used for BPH or overflow incontinence?
    monotherapy for moderate-severe disease with small gland and/or low PSA < 1.5ng/mL
  16. What is the MOA of alpha-1a blockers in BPH or overflow incontinence?
    selective for prostate receptors
  17. What are the SE of alpha-1a blockers?
    • ejaculatory dysfunction
    • sulfa allergy (tamsulosin)
    • priapism (tamsulosin)
  18. What is the MOA of 5-alpha reductase inhibitors in BPH or overflow incontinence?
    Inhibits conversion of testosterone to DHT, preventing prostatic growth
  19. What are the SE of 5-alpha reductase inhibitors?
    • sexual dysfunction
    • gynecomastia
    • decreases PSA
    • Pregnancy category X - don't handle
  20. When are 5-alpha reductase inhibitors used in BPH or overflow incontinence?
    • Moderate-severe disease
    • large gland > 40g and/or high PSA >1.5ng/mL)
Card Set
Geriatric syndromes
Geriatric syndromes