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Geriatric syndromes
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What are the age related changes in physiology that affect pharmacokinetics?
Body composition
:
decreased body water = decreased Vd H
2
O 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
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)
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
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
What are the sx of overflow incontinence?
straining to void
dribbling
frequency
urgency
BPH
mostly MEN
What drugs are used for stress incontinence?
Duloxetine (DOC)
alpha-Adrenergic agonists (pseudoephedrine)(2nd line)
Topical estrogen (pts with urethritis or vaginitis)
Imipramine
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)
What drugs are used for overflow incontinence?
alpha-1 blockers
5-alpah reductase inhibitors
What is the MOA of anticholinergics/antispasmodics in urinary incontinence?
nonselective muscarinic antagonism
What are the SE of anticholinergics/antispasmodics?
dry mouth
blurred vision
constipation
tachycardia
urinary retention
dizziness
confusion
cognitive dysfunction
sedation
erythema (patch)
pruritis (patch)
Which anticholinergic formulation causes the most SE?
immediate release
Which anticholinergic formulations cause the least SE?
extended release
transdermal patch
What is the MOA of alpha-1 blockers in BPH or overflow incontinence?
bladder neck and prostate smooth muscle relaxation
peripheral smooth muscle relaxation
What are the SE of alpha-1 blockers?
first-dose syncope
OH
dizziness
Intraoperative floppy iris syndrome (IFIS)
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
What is the MOA of alpha-1a blockers in BPH or overflow incontinence?
selective for prostate receptors
What are the SE of alpha-1a blockers?
ejaculatory dysfunction
sulfa allergy (tamsulosin)
priapism (tamsulosin)
What is the MOA of 5-alpha reductase inhibitors in BPH or overflow incontinence?
Inhibits conversion of testosterone to DHT, preventing prostatic growth
What are the SE of 5-alpha reductase inhibitors?
sexual dysfunction
gynecomastia
decreases PSA
Pregnancy category X - don't handle
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)
Author
giddyupp
ID
75141
Card Set
Geriatric syndromes
Description
Geriatric syndromes
Updated
2011-03-25T07:15:56Z
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