9 Problem drugs in elderly

Question 1

Diuretics esp. bendro

4

Answer 1

hyponatraemia
dehydration
renal impairment
postural hypotension

Question 2

Antihypertensives
e.g. short acting nifedipine
4

Answer 2

dehydration
renal impairment
postural hypotension
beta-blockers less effectibve due to loss or recptor sensitivity

Question 3

CNS acting agents
esp. TCAs, fluoxetine, long acting BZs (diazepam)
3

Answer 3

postural sway
confusion
falls
(due to increased sensitivity of the CNS to all drugs)

Question 4

Opioids

2

Answer 4

hypotension
constipation
CNS effects

Question 5

NSAIDs

3

Answer 5

fluid retension

GI and renal tox

Question 6

Anticholinergics
e.g. TCA, oxybutanin
4

Answer 6

blurred vision
constipation
confusion
urinary retention

Question 7

long term hypoglycaemics
e.g. glibencamide
1

Answer 7

increased risk of hypos

Question 8

Warfarin

2

Answer 8

Increases sensitivity
increased risk from falls
WARFARIN DOES NOT CAUSE FALLS

Question 9

Digoxin

1

Answer 9

increased risk of tox

no more than 125microg dose

Question 10

Drugs for PD

1

Answer 10

More pronounced s/e

Question 11

Key parameters to measure

Answer 11

Haematology
1. FBC
Biochemistry
2. LFTs
3. U&Es
4. Blood sugar
5. TFTs
6. Blood lipids

7. Body mass index or equivalent
8. Drug therapeutic target ranges

Question 12

Signs of hyponatraemia 3

Answer 12

muscle cramps
slurred speech
confusion

Question 13

signs of hypoglycaemia 8

Answer 13

nausea
cold sweat
weakness
fainting
confusion
headache
bizarre behaviour

Question 14

signs of anaemia 4

Answer 14

tiredness
palpitations
SOB
dizziness

Question 15

signs of hypokalaemia

Answer 15

muscle weakness
intestinal atony (loss of strength)
increased sensitivity to dig
polyuria
poyldypsia