Examl3:lNURS5333/lNURSl5333l(Latest
lUpdate)lFamilylIl|lQsl&lAs|l100%lCorrect|l
GradelAl(VerifiedlAnswers)
Q:lFourlspecificlclassificationsloflmedicationslaccountedlforloverltwo-thirdslofltheselvisits
Answer:
l-Thatlislwarfarin,linsulin,lorallhypoglycemiclmedications,landlorallanti-plateletlmedications.
Q:lThey----
lsolthere'slexcessivelprescribing,landlthere'slpoorladherencelinlthislpopulation,laslwell.lThere'sls
everallreasonslforlthelpoorladherence.lSomeloflitlisltheylcan'tlaffordlthelmedications
Answer:
lhavelmultipleldrugltherapy,
Q:lPrescribinglRXlforlelders
Answer:
lYoulhaveltolhaveltheselpatientslreturnltolthelofficelfrequently.lTheirlregimenlmustlbeladheredlt
o.lThelgoalslofltreatmentlareltolreducelthelsymptomslandlimprovelthelqualitylofllife.
Q:lpharmacokineticlchangeslinlolderladults
Answer:
Q:lAbsorption.lWithlaging,lthelGIltractldoeslproducellesslacidlandlfewerlparietallcells,lbutlthe
lchangelisltoolsmallltolbelclinicallylrelevant.lFrail,lolderladultsldon'tlhavelverylmuchlsubcutane
ouslfat.
Answer:
,lHowever,lthelsmalllchangelcanlbecomelsignificantlinlthelpresenceloflcertainldrugs,lsuchlaslpro
tonlpumplinhibitors.
Q:lAbsorption.lWithlaging
Answer:
lThere'slalsoldecreasedlactiveltransportloflsomeldrugs,lsolitlcanldecreaselbioavailability.lThelrat
eloflabsorptionlalsolslowslwithlage.lThere'slanlincreaselinltotallbodylfat,landlaldecreaselinlsubc
utaneouslfat.
Q:lFrail,lolderladultsldon'tlhavelverylmuchlsubcutaneouslfatltolabsorblRXlsuchlas?
Answer:
lThisldecreaseslthelabsorptionlofltransdermalldrugs.lThislcanlbelimpor-
ltantliflyou'reltryingltolmanagelpainlwithltransdermallpatches.
-Delayedlgastriclemptyinglcanlalsoloccur,landlreducedlsplanchniclbloodlflow,lalso.
Q:lWithlDistribution
Answer:
lThere'slalsolanlincreasedlpercentageloflbodylfat.lLipid-sol-
lubleldrugs,lsuchlaslbenzodiazepines,lhavelalhigherltendencyltolaccumulatelinltheladiposeltissu
e,lresultinglinllowerlserumlconcentrations,lbutlitlalsolincreasesltheldurationloflaction,ldueltolanl
increasedlhalf-life,lbecauseltheldrugsltendltolhanglaroundltherelinltheladiposeltissue.
-leanlmusclelmassldecreaseslaboutl20%,linltotallbodylwaterlbyl10-
15%,lcausinglchangeslinltheldistributionloflmanyldrugs
Q:lPharmaceuticallagentslprimarilyldistributedlinlleanlbodylmasslorlbodylwaterlreachlhigherls
erumlconcentrationslinlolderladults
Answer:
l-leanlmusclelmassldecreaseslaboutl20%,linltotallbodylwaterlbyl10-
15%,lcausinglchangeslinltheldistributionloflmanyldrugs
Q:lNormallaginglalsolresultslinlaldecreaselbylaslmuchlasl20%loflserumlalbuminllevels.lAlbu
minlislthelprimaryldrug-bindinglproteinlinlthelplasma.-
,Answer:
lThelconsequenceloflthislloweredlserumlalbuminllevellislfewerlproteinlmoleculeslavailablelforl
bindingltoltheldrug,landlhigherllevelsloflthelfreelorlunboundldrug.
l
Q:lMetabolismloflrxlwithlelderly
Answer:
lmetabolism,lthislbringsluplthelhepaticlmetabo-
llism,landlthisldeclineslwithlage.lThislislyourlCYP450
Q:lMetabolism:decreaseslwithlage,lcausinglaldecreaselwithltheldruglclear-
lancelandlanlincreasedlhalf-life.
Answer:
lSO=Thislaltersldrug-druglinteractions,laslwell.lFirst-
passlmetabolismlalsoldecreases,landlsoldrugslthatlundergolthelfirst-passlme-
ltabolismlhavelanlincreasedlbioavailabilitylandldecreasedlamountsloflthelprodrugs
Q:lMostldrugslareleliminatedlthroughlthelkidney
Answer:
lgenerallylaboutlal50%ldeclinelinlrenallfunction.lThisldecreasesltubularlsecretionlandldecreasesl
thelrenallclear-lancelofldrugs.
Q:lbecauselofltheldecreaselinlkidneylfunction,lthislislthelmostlimportantlcauselofladverseldrug
lreactionslinlthelolderladultlpopulation.
Answer:
l-
theldecreaselinlkidneylfunction,lthislislthelmostlimportantlcauselofladverseldruglreactionslinlthe
lolderladultlpopulation
-exampleslofldruglclasseslthatlthere'slevidenceloflage-relatedlreductionlinlclear-
lancelincludelyourlantihypertensives,lyourlfibrates,lyourlsedativeslandlhypnotics,landlyourlanxi
olyticlmedications
, Q:lCreatininelclearancelislevaluatedlbestlwithlthelCockcroft-GaultlEquation-
Answer:
lRenallfunctionlneedsltolbelassessed,lwhatlthelbestlmethod?
Q:lAlterationslinlreceptorlpropertieslmaylunderlielsensitivityltolsomeldrugslsuchlas
-there'slalreductionlinlthelnumberloflbeta-
receptors,landlthere'slalreductionlinlthelaffinityloflbeta-receptorslforlbeta-
receptorlblockinglagents
Answer:
lDrugslwithlmorelintenseleffectslarelwarfarinlandlCNSldepressants.lBeta-
blockerslinlthelelderlylare?
Q:lreducedlthermoregulatorylability,landlthislincreaseslhypothermialrisk
Answer:
lHaslaldirectleffectlonlthelphenothiazines,lthelVDCs,landlthelTCAs,landlnarcotics.
Q:limpairedlbaroreceptorlfunctionlandlalteredlfluids,lwhichlcanlcause
Answer:
lpostur-lallhypotensionlwithlanti-hypertensives,landlTCAs,landlMAOIs,landlantihistamines.
Q:lAdverselDruglReactionslarelsevenltimeslmorellikelylinlthelelderly:lhighlrisklforldruglinter
actions,lnotlonlylbecauseloflphysiologiclchanges,lbutlbe-
lcauseloflthelmedicationlpracticesloflbothlhealthlcarelproviderslandlpatients-
Answer:
l-non-
adherencelwithldrugltherapy,leitherlintentionallorlunintentional,landlthislislreportedlinlupltol50
%loflolderladults
