DrVirgo
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50. A 75-year-old man is taking medications for hypertension, hypercholesterolemia, insomnia, and osteoarthritis. An age-related decline in which of the following pharmacokinetic processes is most likely to affect his treatment? A. Gastric absorption
B. Hepatic glucuronidation
C. Hepatic oxidative metabolism
D. Protein binding in the serum
E. Renal tubular secretion
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| tolito
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hmmm. i go with D. plasma proteins are decreased with aging leading to a lower fraction of protein bound and higher free fraction (NSAID'S are protein bound), most SH are lipophilic, there is increased fat in elderly ( this option is not in question)
gastric absorption has not been proven to reducec with age
glucuronidation is not affected by age
hepatic oxidative metabolism (phase 1 reaction?) are reduced with age but he may be given drugs that are not metabolised in the liver
renal tubular secretion??
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| endocrine
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I WLD HAVE JUMPD TO C..LOOKS LIKE I NEED TO GV IT A THOT
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| tolito
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you know what endocrine, i think C is a better answer cos clearly phase I reaction is impaired in the elderly and MOST drugs are metabolised in the liver.
reduced plasma protein is also valid.
hmmmm
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| robin082006
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agree with C
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| rman
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Yeah, Phase I is the first to go in old poeple.
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| mjl1717
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yes phase I is first to go: oxidation, hydroxylation etc.
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| DrVirgo
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Agree with C... Elderly have slowed down Phase I (P450 system slows down).
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| docarchana
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yes C is the right one..
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| young_doc
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Actually....
I remember researching this right after i took this NBME, and i found that the first thing to be affected in terms of pharmacokinetics, is RENAL FUNCTION.
I guess E.
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| X-Ray
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Interesting
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| klimt
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I go with C
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| CaliMD
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Why not E? That's why you adjust the dose right?
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| maoudoody
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i think e as insomnia and osteoarthritis medications excreted through the kidneys
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