9 Elderly - HH Flashcards
Why is prescribing in older people difficult (4)
Multiple pathology
Polypharmacy
Difficulties with adherence
Altered drug handling (physically and PK/PD)
Problem with multiple pathology (2)
interaction between disease states and medicines
lack of appropriate trial data
Unintentional non-adherance issues (5)
Physical difficulty with pack/device poor swallow confusion/memory problems lack of info/poor communication complicated regieme
intentional adherence issues 5
deliberate adjustments lack of confidence in med/Rxer S/e (and concerns about these) lack of info/poor communication complicated regieme
Improving adherance ideas 4
assess use of meds - poping out/inhalers/eye drops
large print labels
plain top bottles
med reminder card
dosset box!
What is the issues with MCA (multicomparment compliance aids)
(4)
need to understand how to use it
take away independence/understanding
many filled to allow carer to prompt
Off label
Stability issues
What to assess before offering compliance aid
knowledge visual manual dexterity cognition supply
Where can you look up if a drug is stable in a compliance aid
medicines compliance aid database
Where can you look up if a drug is stable in a compliance aid
medicines compliance aid database
Changes in absorption:
2 exceptions
reduced by all routes but extent unchanged
Reduced absorption of vit
increased absorption of levodopa
Changes in distribution
Slower distribution.
Reduced water so increased conc of water soluble drugs (dig/gent/theophylline/Li)
Increased fat - prolonged effects of fat soluble (diazepam/phenytoin)
Reduced albumin - increase protein bound drug conc (NSAIDs/furosemide)
Reduced muscle (increased digoxin)
Changes in metabolism
largely there is reserve so ? significance
reduced hepatic perfusion
reduced 1st pass
reduced hepatic enzymes
Changes in elimination
predictable agerelated decrease in renal func
Renal func problems in eledery worsened by
diabetes
infection
cardiac failure
dehydration
Pharmacodynamic changes
"What the drug does to the body" changes in target organ responsiveness loss of homeostatic mechanism changes in target receptor sensitivity (increased effect of CNS acting drugs, decreased efficacy of beta blockers)
