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401 - Content > Care Of The Elderly > Flashcards

Care Of The Elderly Flashcards

1
Q

How is distribution, metabolism and excretion affected with aging

A

Distribution
• increase in body mass/weight - higher volume of distribution for lipophilic drugs
• decrease in total body water - less distribution for hydrophilic drugs

Metabolism
• shrinkage of liver and reduced body flow = decrease in drug metabolism

Excretion
• decrease in CrCl
• poor function of glomerular and tubules
^ effects drug excretion

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2
Q

What happens when someone’s with COPD or asthma takes propranolol

A

Bronchocontriction

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3
Q

What happens if someone is at risk of falls is taking antihypertensives

A

Increase risk of falls

(Same with amitriptyline)

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4
Q

What happens is someone with bladder output obstruction is taking Oxybutynin

A

Urinary retention

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5
Q

What happens if someone with constipation is taking iron or ca supplements

A

Exacerbation of constipation

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6
Q

What happens if someone with a blood disorder takes NSAIDs

A

Increased bleeding risk

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7
Q

Structured medicine review (SMR)

A

An intervention to help those with problematic polypharmacy

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8
Q

What are the main drug therapy problems

A

• adherence
• doses too high
• doses to low
• ineffective drug
• no need for the drug
• need for additional therapy

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9
Q

Define polypharamcy

A

Take 5 or more medicines

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10
Q

Cause of polyoharamcy

A

• lack of medication reviews
• lack of communication between prescribed and patient
• muti morbidities

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11
Q

What does medicine optimisation encourage - NG5

A

• medication reviewed
• medication reconciliation
• professional collaborations
• person centred decisions (patient decision aids)

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12
Q

When reviewing meds we use the STOPP/START tool. What is this?

A

STOPP
• identifies inappropriate prescribing in the elderly
• decrease the risk of ADRS

START
• helps prevent neglect of appropriate/necessary medicines

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13
Q

Are statins for primary prevention (20mg) beneficial in elderly?

A

No

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14
Q

True or false - START criteria can identify medications that a patient should be on but is not

A

True

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15
Q

True or false - digoxin dose of >125mcrg is appropriate in geriatric patients

A

False

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16
Q

After how many years of take biphosphantes does it show no effectiveness

A

5> years

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17
Q

Examples of drugs which should be used for short term

A

• BZDs
• PPI
• NSAIDs

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18
Q

Medications associates with withdrawel related ADRs

A
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19
Q

Withdrawel of BZDs

A

• anxiety
• agitation
• delirium
• insomnia
• seizures

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20
Q

Withdrawel of corticosteroids

A

• anorexia
• hypotension

21
Q

Withdrawel of BB

A

• angina
• hypertension
• tachycardia

22
Q

Withdrawel of anticonvulsants/antiepileptics

A

• sezuires
• anxiety
• depression

23
Q

< all those have an increased risk of discontinuation syndrome

24
Q

Now, decreased risk of discontinuation syndrome

25
Q

Withdrawel of Analgesics

A

• fever
• insomnia
• anxiety
•abdominal pain

26
Q

Withdrawel of diuretics

A

• odema
• HTN
• HF

27
Q

Withdrawel of - digoxin

A

• tachycardia
• HF

28
Q

Withdrawel of ACEI

A

• HTN
• HF

29
Q

Steps before deprescribing

A

• check the adherence of the drug
• check diagnosis and indication
• check the appropriateness
• risk of deprescribing
• speak with the patient
• one drug at a time
• monitor

30
Q

Harms of deprescribing

A

• withdrawal symptoms
• rebound of condition
• reappearance of symptoms

31
Q

Barriers of deprescribing

A

• time consuming
• if multiple prescribers involved - co-ordination of professionals
• from patient: they may think they need the medicine, anxious about cessation

32
Q

Steps for deprescribing BZDs

A

Step 1
• convert dose of original drug to daily dose of diazepam

Step 2
• with low doses - reduce dose by 1-2mg every 2-4 weeks
• with high doses - reduce dose by 1 tenth every 1-2 weeks

Step 3
• towards the end taper down in steps of 500mcrg then stop

33
Q

Steps for deprescribing antipsychotics

Halperidol
Risperidone

A

If daily dose is 500mcrg - stop

If daily dose is up to 1mg
• halve
• then stop

If daily dose is over 1mg
• halve
• halve
• then stop

34
Q

How to taper down SSRI or venlaxafine

A

Reduce dose by 25% every 4-6 weeks

35
Q

How to taper down TCA - eg amitriptyline

A

Reduce dose by 25% every 4 weeks

36
Q

HTN target in over and under 80s

A

Over 80 - 150/90

Under 80 - 140/90

37
Q

HTN target in diabetics + those with renal or eye impairments

A

140/80

130/80 - renal and eye

38
Q

Which drugs increase the risks of falls

A

• Antihypertensives
• Antipsychotics
• Andidepressents
• Antiepletics
• antihistamines

39
Q

Which 2 drugs taken together can cause nephrotoxicity

A

Paracetamol and simvastin

40
Q

Overdue of constipation medication can lead to..

A

• diarrhoea
• dehydration
• hypokalaemia - arrhythmia, electrolyte imbalance

41
Q

Amitriptyline is an anticholinergic, what are the ADRs

A

Cognitive issues
Urinary retention
Blurred vision
Constipation
Dry mouth
Falls

42
Q

Which drugs can be used for neuropathic pain?

A

• amytripyline
• duloxitine
• gabapentin
• pregabalin

43
Q

What drug is used for sezuires

A

Levetiracetam

44
Q

Instead of using Oxybutynin for urinary incontinence what non pharmacological approach

A

Incontinence pads

45
Q

Why should metformin not be used in Elderly

A

Metabolic acidosis

46
Q

If a patient is on sulfonylureas what should this be changed to

A

SGLT2 inhibitors

(Cardioprotective)

47
Q

Tamsulosin and Doxasosin are both alpha blockers , what can this cause

A

Orthostatic hypotension

48
Q

If a patient is on a TCA what can this be changed to

401 - Content (18 decks)

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