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Year 3 Ageing > Ageing deck 2 > Flashcards

Ageing deck 2 Flashcards

1
Q

What is reablement?

A

Individual regaining skills, confidence and independence to enable them to do things for themselves

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2
Q

What are the principles of rehabilitation and reablement?

A

Person centred
Goal directed
Co-ordinated
Improved outcomes

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3
Q

What are pharmacokinetics?

A

Absorption
Distribution
Metabolism
Excretion

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4
Q

What are pharmacodynamics?

A

Drug action on the body

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5
Q

If a drug is excreted by the kidney, what should you consider?

A

Dose deduction

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6
Q

If a person has cachexia or a low weight, what should you consider doing?

A

Changing the dose (lowering it)

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7
Q

What type of environment do acidic drugs require in order to be absorbed?

A

Acidic environment

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8
Q

What type of environment do basic drugs require in order to be absorbed?

A

Basic environment

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9
Q

Name some acidic drugs (3)

A

Phenytoin
Aspirin
Penicillins

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10
Q

Name some basic drugs (3)

A

Diazepam
Morphine
Pethidine

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11
Q

Why should you consider drug delivery in elderly patients?

A

Dysphagic or confused patients will not be able to swallow tablets etc

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12
Q

What protein binds to acidic drugs?

A

Albumin

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13
Q

Is albumin acidic or basic?

A

Basic

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14
Q

If you administer penicillin to a patient with low albumin, why would the drug not be absorbed well?

A

Penicillin (acidic) binds to albumin however there is not a lot of albumin so not a lot of penicillin can be absorbed

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15
Q

What protein binds to basic drugs?

A

Alpha-1 acid glycoprotein

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16
Q

Is Alpha-1 acidic glycoprotein basic or acidic?

A

Acidic

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17
Q

Do elderly patients tend to have:

High/low albumin
High/low A-1 AG?

A

Low albumin

High A-1 AG

18
Q

Why do the elderly have increased lipid binding?

A

Increased fat to muscle ratio

19
Q

Why should you perhaps lower the doses of lipophilic drugs when giving them to the elderly?

A

Increased proportion of fat means increased VD of lipophilic drugs and a longer half life

20
Q

What is the volume of distribution?

A

Theoretical volume if all of the drug you gave a patient was completely absorbed and distributed within the plasma

21
Q

Why are lipophilic drugs particularly dangerous in the elderly?

A

Sit in fatty tissue for a long time.

Any period of cachexia and then the drug will be released as fat breaks down

22
Q

What type of drug has a low volume of distribution in the elderly and why?

A

Hydrophilic drug

Decreased body water

23
Q

What is the biological half life of a drug?

A

Time it takes for a drug to get down to half of its biological/pharmacological activity

24
Q

Why do elderly people have a reduced liver function?

A

Decreased liver size and blood flow and disease

First pass metabolism reduced

25
Q

Why do elderly people have a slower renal metabolism?

A

Lower GFR due to decreased:

  • size
  • tubular secretion
  • renal blood flow
26
Q

Lower doses achieve the same affect in the elderly.

True or false?

A

True

27
Q

What are some drugs with a narrow therapeutic index e.g. <2?

A 
Theophylline
Warfarin
Lithium
Digoxin
Gentamicin
Vancomycin
Phenytoin
Cyclosporin
Carbamazepine
Levothyroxine
28
Q

What drugs are most frequently associated with adverse reactions in the elderly?

A 
Warfarin
Digoxin
Insulin
Benzodiazepines
Diuretics
NSAIDs
Corticosteroids
Anti-hypertensive agents
Opioids 
Theophylline
29
Q

If you are going to prescribe an opioid to an elderly patient, what should you prescribe in addition to this?

A

Lactulose or senna (laxitives)

30
Q

What do you need to consider when prescribing steroids in the elderly?

A

Osteoporosis prevention if long term.

Steroid induced diabetes.

31
Q

What interferes with absorption of levothyroxine?

A

Calcium

32
Q

What drug is just as effective as NSAIDs in mild OA?

A

Paracetamol

33
Q

What are the risks of taking NSAIDs, especially in the elderly?

A

GI haemorrhage
Decline in GFR
Decreased effectiveness of diuretics and anti-hypertensives

34
Q

If you really have to give an elderly patient an NSAID, what should you prescribe them?

A

Ibuprofen or naproxen

35
Q

What are the adverse effects of taking opioids and benzodiazepines?

A

Impairs psychomotor function

Falls and confusion

36
Q

What GI drugs should you stop in the elderly?

A

Loperamide or codeine phosphate

Prochlorperazine or metoclopramide

Stimulant laxitives

37
Q

What GI drugs should you start in the elderly?

A

PPI

Fibre supplement

38
Q

What CV drugs should you stop in the elderly?

A

Beta-blocker

Non-cardioselective beta-blocker

Calcium channel blockers

Dipyridamole

Statins

39
Q

Why should you stop beta-blockers in the elderly?

A

Risk of symptomatic heart block

40
Q

Why should you stop non-selective beta-blockers in patients with COPD?

A

Risk of bronchospasm

41
Q

What CV drugs should you consider starting in the elderly?

A

Antihypertensive

ACEi

PPI

Warfarin/DOACs

Year 3 Ageing (9 decks)

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