9 Elderly Flashcards
Questions to ask looking at elderly drugs 6
Is there and indication? Are their untreated indications? Therapy appropriate for the indication?
Interactions or contraindications?
Therapeutic monitoring up to date?
Is there evidence of efficacy? Evidence that clinical review has taken place and therapy is still required?
Dosing schedule/formulation appropriate?
Does the patient understand/comply?
Side Effects reported by patient and recorded?
Classes of medication associated with falls
NSAIDS
Opioids
Other sedatives and hypnotics (antihistamines and sleeping)
Diuretics
Antipsychotics Beta block Antidepressants BZs Anti hypertensives
Why don’t we use phenothiazines for dizziness due to postural hypotension
Themselves cause postural hypertension
Neuroleptics for confusional state?
Cause confusion and low BP
Levodopa for non parkinsons tremor
Not cause by low da
BZ for insomnia from depression
Treat the depression
Worsens cognition
Loop diuretics for dependant oedema
Ineffective.
Compression stockings
BZ ever.,
No - risk of cognitive impairment and falls
Long acting oral hypoglycemics
No hypos in elderly particularly hard to notice and renal function could prolong effet
ACh for Parkinson’s disease
Increased cognition problems and antimuscurinic sideeffects
Muscle relaxants for spasticity
Not specific to those muscles so they increase risk of falls
Amitryptiline for neuropathic pain?
No - antichlinegic. Change to GABA or pregab
Cause weight in paracetamol
Below 50kg
Old people pain relief steps
Paracetamol then co-codamol then morhpine.
Don’t use NSAIDS due to cv risk and bleeding
In all patients in the case situ does consider
Oestoperosis
Constipation
VTE
Cv risk
Diabetes control
