308 Core Drugs - Elderly Care

Question 1

What is Aspirin?

Answer 1

• Aspirin is a nonsteroidal anti-inflammatory drug (NSAID).
• Aspirin is a common drug for relieving minor aches, pains, and fevers. People also use it as an anti-inflammatory or a blood thinner.

Question 2

When is aspirin used in the elderly?

Answer 2

Prophylactic aspirin in healthy, elderly patients provides no benefit and causes harm; clinicians should not use it for primary prevention in otherwise well patients aged over 70. May be used in secondary prevention when benefit outweighs the risk.

Question 3

The usual dose of aspirin to prevent a heart attack or stroke is … mg once a day (a regular strength tablet for pain relief is 300mg)

Answer 3

The usual dose to prevent a heart attack or stroke is 75mg once a day (a regular strength tablet for pain relief is 300mg)

Question 4

What is Atorvastatin?

Answer 4

Atorvastatin belongs to a group of medicines called statins. It’s used to lower cholesterol if you’ve been diagnosed with high blood cholesterol

Question 5

How should I manage people with a CVD risk of 10% or more?

Answer 5

Offer statin treatment after risk assessment if lifestyle modification is ineffective or inappropriate.

Question 6

What drug treatments should I offer for the primary prevention of CVD?

Answer 6

Offer atorvastatin 20 mg a day (unless contraindicated) for the primary prevention of cardiovascular disease (CVD) to people with an estimated CVD risk of 10% or more calculated using the QRISK3 assessment tool.

Question 7

… is not recommended for the primary prevention of CVD.

Question 8

What is Clopidogrel?

Answer 8

Clopidogrel is an antiplatelet medicine. It prevents platelets (a type of blood cell) from sticking together and forming a dangerous blood clot.

Question 9

What dosage of clopidogrel is given?

Answer 9

• The usual dose for clopidogrel is 75mg once a day.
• Your doctor may prescribe clopidogrel with or instead of low-dose aspirin.

Question 10

What is Movicol ?

Answer 10

It is a laxative for the treatment of constipation in adults, adolescents and elderly. It is not recommended for children below 12 years of age. Movicol helps you to have a comfortable bowel movement even if you have been constipated for a long time. Movicol also works in very bad constipation called faecal impaction.

Question 11

What type of laxative is movicol?

Answer 11

Movicol sachets and liquid contain macrogol (polyethylene glycol ‘3350’), which is a type of medicine known as an osmotic laxative.

Question 12

What is rivaroxaban?

Answer 12

Rivaroxaban is a type of medicine known as an anticoagulant, or blood thinner.

Question 13

AF dose - Rivaroxaban

Answer 13

atrial fibrillation – the usual dose is 20mg a day

Question 14

had an operation to replace a hip or knee joint - Rivaroxaban dose

Answer 14

had an operation to replace a hip or knee joint – the usual dose is 10mg a day.

Question 15

had a blood clot (DVT or pulmonary embolism) - Rivaroxaban dose

Answer 15

the usual dose is 20mg a day. You might need to take a dose of 15mg twice a day for the first few weeks of taking rivaroxaban. If you have kidney disease and are at a higher risk of bleeding, your doctor may prescribe a lower dose.

Question 16

had a heart attack or have a heart condition called unstable angina – Rivaroxaban dose

Answer 16

had a heart attack or have a heart condition called unstable angina – the usual dose is 2.5mg twice a day.

Question 17

What is senna?

Answer 17

Senna is used on a short-term basis to treat constipation. It also is used to empty the bowels before surgery and certain medical procedures.

Question 18

What type of laxative is senna?

Answer 18

Senna is known as a stimulant laxative – it stimulates the muscles that line your gut, helping them to move poo along your bowel.

Question 19

Senna dosing

Answer 19

7.5–15 mg daily (max. per dose 30 mg daily), dose usually taken at bedtime; initial dose should be low then gradually increased, higher doses may be prescribed .

Question 20

What is Warfarin?

Answer 20

Warfarin is the main oral anticoagulant used in the UK. Oral means it’s taken by mouth. An anticoagulant is a medicine that stops blood clotting.

Question 21

How does warfarin work?

Answer 21

• Warfarin is the main oral anticoagulant used in the UK. Oral means it’s taken by mouth. An anticoagulant is a medicine that stops blood clotting.
• Clotting (thickening) is a complex process involving a number of substances called clotting factors.
• Clotting factors are produced by the liver and help control bleeding. They work with cells that trigger the clotting process (platelets) to ensure blood clots effectively.
• To produce some of the clotting factors, the liver needs a good supply of vitamin K.
• Warfarin blocks one of the enzymes (proteins) that uses vitamin K to produce clotting factors. This disrupts the clotting process, making it take longer for the blood to clot.

Question 22

When is warfarin prescribed?

Answer 22

Anticoagulant medicines, such as warfarin, are often prescribed for people who’ve had a condition caused by a blood clot, such as:

• a stroke
• a heart attack
• deep vein thrombosis – a blood clot within a deep vein in the body, usually in a leg
• pulmonary embolism – a blood clot in the lungs

Warfarin may also be prescribed for people at an increased risk of developing harmful blood clots, such as those with:

• a replacement or mechanical (prosthetic) heart valve
• an irregular heart rhythm, known as atrial fibrillation
• a blood clotting disorder, such as thrombophilia
• an increased risk of blood clots following surgery

Question 23

Starting dose for warfarin?

Answer 23

The usual warfarin dose is 10mg a day for the first 2 days, then between 3mg and 9mg a day after that.

Question 24

You need to have blood tests at least every 12 weeks while you’re taking warfarin to make sure your dose is right. What blood test is done? what does it measure?

Answer 24

Getting this balance right means your dose of warfarin must be carefully monitored. You’ll have a regular blood test called the international normalised ratio (INR). It measures how long it takes your blood to clot. The longer your blood takes to clot, the higher the INR.

Question 25

For people with atrial fibrillation, there is no need to achieve anticoagulation rapidly; a slow-loading regimen is safe and achieves therapeutic anticoagulation in most people within 3–4 weeks. Warfarin … or … is generally an acceptable starting dose. The average daily maintenance dose is usually around … mg daily; however, there is wide variation, and the daily dose may be between … -…. mg for some people.

Answer 25

For people with atrial fibrillation, there is no need to achieve anticoagulation rapidly; a slow-loading regimen is safe and achieves therapeutic anticoagulation in most people within 3–4 weeks. Warfarin 1 mg or 2 mg daily is generally an acceptable starting dose. The average daily maintenance dose is usually around 5 mg daily; however, there is wide variation, and the daily dose may be between 1–15 mg for some people.

Question 26

The anticoagulant effect of warfarin is measured as the .. .. ..

Answer 26

The anticoagulant effect of warfarin is measured as the international normalized ratio (INR).

Question 27

• Generally, the INR should be measured:
  
  • Daily, or on alternate days, until it is within the therapeutic range (usually between…-…, ideally ….) on two consecutive occasions.
  • Although the INR may be measured each day after starting warfarin, a meaningful INR can only be obtained …-… days after starting treatment.
  • Then, twice weekly for …-… weeks, followed by weekly measurements until at least two INR measurements are within the therapeutic range.
  • Thereafter, depending on the stability of the INR, at longer intervals (for example, up to every … weeks) if agreed locally. Once a stable warfarin dose that controls the INR has been established, changes in dose are seldom required.

Answer 27

• Generally, the INR should be measured:
  
  • Daily, or on alternate days, until it is within the therapeutic range (usually between 2–3, ideally 2.5) on two consecutive occasions.
  • Although the INR may be measured each day after starting warfarin, a meaningful INR can only be obtained 3–4 days after starting treatment.
  • Then, twice weekly for 1–2 weeks, followed by weekly measurements until at least two INR measurements are within the therapeutic range.
  • Thereafter, depending on the stability of the INR, at longer intervals (for example, up to every 12 weeks) if agreed locally. Once a stable warfarin dose that controls the INR has been established, changes in dose are seldom required.

Question 28

A target INR of 2.5 is recommended for:

Answer 28

Treatment of deep vein thrombosis (DVT) or pulmonary embolism (PE), including those associated with antiphospholipid syndrome or for recurrence in people no longer receiving warfarin treatment.

Atrial fibrillation.

Cardioversion (higher target values, such as an INR of 3, can be used for up to 4 weeks before the procedure to avoid cancellations due to low INR).

Mitral stenosis or regurgitation with atrial fibrillation, history of systemic embolism, left atrial thrombus, or enlarged left atrium.

Bioprosthesis in the mitral position.

Bioprosthetic valve and history of systemic embolism.

Bioprosthetic valve and left atrial thrombus at surgery.

Bioprosthetic valves and other prothrombotic risk factors, such as atrial fibrillation and low ventricular ejection fraction.

Acute arterial embolism leading to embolectomy.

Dilated cardiomyopathy.

Post myocardial infarction.

Question 29

A target INR of 3.5 is recommended for:

Answer 29

Recurrent DVT or PE in people currently receiving anticoagulation and with an INR above 2.