Chapter-8 Elderly

Question 1

How is absorption altered in elderly people

Answer 1

Reduced rate of absorption by all routes but extent of absorption is unchanged

Question 2

Increased or decreased absorption of vitamins in elderly?

Answer 2

Decreased

Question 3

Increased or decreased absorption of levodopa in elderly and why?

Answer 3

Increased due to less dopa decarboxylase in gastric mucosa

Question 4

List five changes that affect the distribution of drugs in elderly

Answer 4

Reduced perfusion 
Reduced body water 
Increased body fat 
Reduced albumin 
Reduced muscle

Question 5

What does reduced body water mean for elderly

Answer 5

Increased plasma concentration of water soluble drugs such as digoxin, gentamicin, theophylline, lithium

Question 6

What does increased body fat mean for elderly

Answer 6

Prolonged effects of fat soluble drugs e.g diazepam and phenytoin

Question 7

What effects does reduced albumin have on distribution

Answer 7

Increased free concentrations of protein bound drugs such as warfarin, furosemide, NSAIDs

Question 8

What’s the impact of reduced muscle in elderly patients

Answer 8

Increased free concentration of muscle bound drugs

Question 9

What metabolic changes occur in elderly

Answer 9

Reduced hepatic perfusion
Reduced first pass metabolism
Reduced hepatic enzymes

Question 10

What’s the most significant pharmacokinetic change in elderly

Answer 10

Decline in kidney function

Question 11

What acute problems can worsen kidney function

Answer 11

Dehydration
Cardiac failure
Diabetes
Infection

Question 12

Should you use CrCl or eGFR in elderly?

Answer 12

CrCl

Question 13

How are pharmacodynamics

effected in the body

Answer 13

Changes in target receptor sensitivity:
-increased effects of CNS acting drugs 
- decreased efficacy of beta-blockers 
Changes in target organ response 
Loss of homeostatic mechanisms

Question 14

What does the STOPP tool stand for

Answer 14

Screening took of older persons prescriptions

Question 15

What does START tool stand for

Answer 15

Screening tool to alert doctors to right treatment

Question 16

Why are NSAIDs not good in heart failure

Answer 16

Increase fluids retention and bleeding risk

Question 17

Metoclopramide in Parkinson’s

Answer 17

NO NO

Question 18

Long term digoxin >125mcg with impaired renal function is on the STOPP tool what can it cause

Answer 18

Bradycardia
Yellow vision
Vomiting

Question 19

Three examples on the START tool

Answer 19

Warfarin in chronic AF
ACEI in chronic heart failure
Bisphosphonates in patients on maintenance corticosteroids

Question 20

True/false: elderly patient have increased sensitivity to psychotropic drugs

Answer 20

True

Question 21

BP target in elderly

Answer 21

150/100 ( due to falls risk)

Question 22

List 6 classes of problem drugs in elderly

Answer 22

Diuretics(Bendro) 
Antihypertensives 
CNS agents 
Opioids 
NSAIDs
Anticholinergics

Question 23

Signs of hyponatraemia

Answer 23

Muscle cramps
Slurred speech
Confusion

Question 24

Signs of hypoglycaemia

Answer 24

Nausea 
Sweating 
Weakness
Confusion 
Cold sweats 
Bizarre behaviour

Question 25

Signs of anaemia

Answer 25

Tiredness
Palpitations
SoB
Dizziness

Question 26

Signs of hypokalaemia

Answer 26

Muscle weakness 
Intestinal atony
Sensitivity to digoxin 
Polyuria
Polydipsia

Question 27

Six main reasons why elderly may struggle with taking meds

Answer 27

1) memory
2) vision
3) hearing
4) dexterity
5) swallowing
6) scheduling logistics

Question 28

What’s the only licensed antipsychotic in dementia for aggressive behaviour

Answer 28

Risperidone

Question 29

True false: patients with dementia, use of antipsychotic drugs increases risk of what

Answer 29

Stroke and mortality

Question 30

Name two drugs that can be used to calm an aggressive dementia patient down acutely

Answer 30

Lorazepam

Olanzapine

Question 31

Which AD comes in a patch form to minimised GI effects

Answer 31

Rivastigmine