Geriatrics
What kind of metabolism is mostly unchanged in geriatric patients?
Phase II (glucurodination)
How to take an oral bisphosphonate:
Stay upright for 30-60 mins following dose
Wait 30-60 mins before eating/drinking something else
What causes nausea in pregnancy (hint: this is also what gets detected in pregnancy tests)?
Dogs/cats have a _____ subcutaneous space.
What are the implications for pharmacy?
Large; subQ route approximates IV in dogs/cats
Which one of these two drugs exhibits concentration-dependent killing and has a post-antibiotic effect?
Aminoglycosides
What is considered the pharmacokinetic parameter that is MOST affected by the aging process?
What formula should be used to measure it in geriatrics?
Renal elimination
Cockcroft-Gault
Why are bisphosphonates considered "vampires"?
They stay in the bone and have effects even after discontinuation
Vd = increased
Protein binding = decreased
GFR = increased (by ~50%)
Dogs: what does the ABCBI polymorphism do?
More prone to CNS toxicity with PGP substrates due to defective BBB PGP
Calculate Ke for aminoglycoside dosing (pop parameters):
Ke = (0.0024 x CrCl) + 0.01
Geriatric patients are particularly prone to what class of drugs?
Anticholinergics
Rebound fractures
Lamotrigine and pregnancy: what happens?
Pregnancy increases the clearance of lamotrigine by A LOT. Need to increase dosing of lamotrigine for pregnant patients.
Cats have a very acidic GI pH, except in the ______.
What are the implications for pharmacy?
Saliva; can administer weakly basic buccal drugs
Calculate Ke for vancomycin dosing (pop parameters):
Ke = (0.0083 x CrCl) + 0.0044
In geriatric patients, alpha blockers should not be used for what indication?
Hypertension
Bonus: which PTH analog has to be taken longer?
SC once daily for 18-24 months, followed by antiresorptive therapy
Teriparatide = 24 months
Abaloparatide = 18 months
Caffeine intake for pregnant patients should be...
<200 mg/day
Cats: what is the PGP ABCG2 anomaly?
Renders retina particularly sensitive to fluoroquinolones (photoreactive)
Obesity cutoffs for CrCl, aminoglycoside standard dosing, aminoglycoside ODA dosing, vancomycin dosing
CrCl: 130%
Aminoglycoside standard: 130%
Aminoglycoside ODA: 120%
Vanc: N/A (always use TBW)
In geriatric patients, digoxin dosing for Afib should not exceed:
0.125 mg per day
What drug for osteoporosis uncouples osteoblast and osteoclast activity, but is associated with increased CV risk?
Romosozumab (sclerostin inhibitor)
Desired M/P ratio and RID?
M/P < 1
RID < 10%
Which vet drug resource is online? Which was written by a DVM from NC State and is widely utilized by vets, especially in NC?
Online: Plumb's
DVM: Papich
ODA aminoglycoside dose calculation:
Dosing interval based on:
Dose = 7 mg/kg x TBW
(ADBW if 120% of IBW)
Interval based on CrCl