Chapter-8 Elderly Flashcards
How is absorption altered in elderly people
Reduced rate of absorption by all routes but extent of absorption is unchanged
Increased or decreased absorption of vitamins in elderly?
Decreased
Increased or decreased absorption of levodopa in elderly and why?
Increased due to less dopa decarboxylase in gastric mucosa
List five changes that affect the distribution of drugs in elderly
Reduced perfusion Reduced body water Increased body fat Reduced albumin Reduced muscle
What does reduced body water mean for elderly
Increased plasma concentration of water soluble drugs such as digoxin, gentamicin, theophylline, lithium
What does increased body fat mean for elderly
Prolonged effects of fat soluble drugs e.g diazepam and phenytoin
What effects does reduced albumin have on distribution
Increased free concentrations of protein bound drugs such as warfarin, furosemide, NSAIDs
What’s the impact of reduced muscle in elderly patients
Increased free concentration of muscle bound drugs
What metabolic changes occur in elderly
Reduced hepatic perfusion
Reduced first pass metabolism
Reduced hepatic enzymes
What’s the most significant pharmacokinetic change in elderly
Decline in kidney function
What acute problems can worsen kidney function
Dehydration
Cardiac failure
Diabetes
Infection
Should you use CrCl or eGFR in elderly?
CrCl
How are pharmacodynamics
effected in the body
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
What does the STOPP tool stand for
Screening took of older persons prescriptions
What does START tool stand for
Screening tool to alert doctors to right treatment
Why are NSAIDs not good in heart failure
Increase fluids retention and bleeding risk
Metoclopramide in Parkinson’s
NO NO
Long term digoxin >125mcg with impaired renal function is on the STOPP tool what can it cause
Bradycardia
Yellow vision
Vomiting
Three examples on the START tool
Warfarin in chronic AF
ACEI in chronic heart failure
Bisphosphonates in patients on maintenance corticosteroids
True/false: elderly patient have increased sensitivity to psychotropic drugs
True
BP target in elderly
150/100 ( due to falls risk)
List 6 classes of problem drugs in elderly
Diuretics(Bendro) Antihypertensives CNS agents Opioids NSAIDs Anticholinergics
Signs of hyponatraemia
Muscle cramps
Slurred speech
Confusion
Signs of hypoglycaemia
Nausea Sweating Weakness Confusion Cold sweats Bizarre behaviour
Signs of anaemia
Tiredness
Palpitations
SoB
Dizziness
Signs of hypokalaemia
Muscle weakness Intestinal atony Sensitivity to digoxin Polyuria Polydipsia
Six main reasons why elderly may struggle with taking meds
1) memory
2) vision
3) hearing
4) dexterity
5) swallowing
6) scheduling logistics
What’s the only licensed antipsychotic in dementia for aggressive behaviour
Risperidone
True false: patients with dementia, use of antipsychotic drugs increases risk of what
Stroke and mortality
Name two drugs that can be used to calm an aggressive dementia patient down acutely
Lorazepam
Olanzapine
Which AD comes in a patch form to minimised GI effects
Rivastigmine
