Ageing deck 2 Flashcards
What is reablement?
Individual regaining skills, confidence and independence to enable them to do things for themselves
What are the principles of rehabilitation and reablement?
Person centred
Goal directed
Co-ordinated
Improved outcomes
What are pharmacokinetics?
Absorption
Distribution
Metabolism
Excretion
What are pharmacodynamics?
Drug action on the body
If a drug is excreted by the kidney, what should you consider?
Dose deduction
If a person has cachexia or a low weight, what should you consider doing?
Changing the dose (lowering it)
What type of environment do acidic drugs require in order to be absorbed?
Acidic environment
What type of environment do basic drugs require in order to be absorbed?
Basic environment
Name some acidic drugs (3)
Phenytoin
Aspirin
Penicillins
Name some basic drugs (3)
Diazepam
Morphine
Pethidine
Why should you consider drug delivery in elderly patients?
Dysphagic or confused patients will not be able to swallow tablets etc
What protein binds to acidic drugs?
Albumin
Is albumin acidic or basic?
Basic
If you administer penicillin to a patient with low albumin, why would the drug not be absorbed well?
Penicillin (acidic) binds to albumin however there is not a lot of albumin so not a lot of penicillin can be absorbed
What protein binds to basic drugs?
Alpha-1 acid glycoprotein
Is Alpha-1 acidic glycoprotein basic or acidic?
Acidic
Do elderly patients tend to have:
High/low albumin
High/low A-1 AG?
Low albumin
High A-1 AG
Why do the elderly have increased lipid binding?
Increased fat to muscle ratio
Why should you perhaps lower the doses of lipophilic drugs when giving them to the elderly?
Increased proportion of fat means increased VD of lipophilic drugs and a longer half life
What is the volume of distribution?
Theoretical volume if all of the drug you gave a patient was completely absorbed and distributed within the plasma
Why are lipophilic drugs particularly dangerous in the elderly?
Sit in fatty tissue for a long time.
Any period of cachexia and then the drug will be released as fat breaks down
What type of drug has a low volume of distribution in the elderly and why?
Hydrophilic drug
Decreased body water
What is the biological half life of a drug?
Time it takes for a drug to get down to half of its biological/pharmacological activity
Why do elderly people have a reduced liver function?
Decreased liver size and blood flow and disease
First pass metabolism reduced
Why do elderly people have a slower renal metabolism?
Lower GFR due to decreased:
- size
- tubular secretion
- renal blood flow
Lower doses achieve the same affect in the elderly.
True or false?
True
What are some drugs with a narrow therapeutic index e.g. <2?
Theophylline Warfarin Lithium Digoxin Gentamicin Vancomycin Phenytoin Cyclosporin Carbamazepine Levothyroxine
What drugs are most frequently associated with adverse reactions in the elderly?
Warfarin Digoxin Insulin Benzodiazepines Diuretics NSAIDs Corticosteroids Anti-hypertensive agents Opioids Theophylline
If you are going to prescribe an opioid to an elderly patient, what should you prescribe in addition to this?
Lactulose or senna (laxitives)
What do you need to consider when prescribing steroids in the elderly?
Osteoporosis prevention if long term.
Steroid induced diabetes.
What interferes with absorption of levothyroxine?
Calcium
What drug is just as effective as NSAIDs in mild OA?
Paracetamol
What are the risks of taking NSAIDs, especially in the elderly?
GI haemorrhage
Decline in GFR
Decreased effectiveness of diuretics and anti-hypertensives
If you really have to give an elderly patient an NSAID, what should you prescribe them?
Ibuprofen or naproxen
What are the adverse effects of taking opioids and benzodiazepines?
Impairs psychomotor function
Falls and confusion
What GI drugs should you stop in the elderly?
Loperamide or codeine phosphate
Prochlorperazine or metoclopramide
Stimulant laxitives
What GI drugs should you start in the elderly?
PPI
Fibre supplement
What CV drugs should you stop in the elderly?
Beta-blocker
Non-cardioselective beta-blocker
Calcium channel blockers
Dipyridamole
Statins
Why should you stop beta-blockers in the elderly?
Risk of symptomatic heart block
Why should you stop non-selective beta-blockers in patients with COPD?
Risk of bronchospasm
What CV drugs should you consider starting in the elderly?
Antihypertensive
ACEi
PPI
Warfarin/DOACs
