Clinical pharmacology of older age 2

Question 1

What are some of the reasons why adverse drug reactions occur ?

Answer 1

1. Drug-drug interactions
2. Drug-disease interactions
3. Drug-food interactions
4. Drug side effects
5. Drug toxicity

Question 2

Give some examples of common drug to drug reactions which can occur ?

Answer 2

1. Theophylline and Macrolide Antibiotics
2. Statins and Macrolides / Statins and Fibrates
3. TCAs and type 1 Anti-arrythmics
4. Warfarin and multiple drugs
5. ACE inhibitors increase hypoglycemic effect of sulfonylureas
6. Clopidogrel and PPI’s

Question 3

What are some of the common drug OTC/herbal interactions ?

Answer 3

1. Vitamin C ==> Grapefruit Juice
2. Dementia ==> Gingko biloba
3. BPH (benign prostatic hyperplasia) ==> Saw palmetto
4. OA (oesteoarthritis) ==> Glucosamine
5. Depression ==> St. John’s Wort

Question 4

What are some of the common drug to disease interactions ?

Answer 4

• Patient with PD have increased risk of drug induced confusion
• NSAIDs/COX-2/TZD’s can exacerbate CHF
• Urinary retention in BPH patients on decongestants or anticholinergics
• Constipation worsened by calcium, anticholinergics, calcium channel blockers
• Neuroleptics, tramadol and quinolones lower seizure thresholds
• Beta blockers and asthma

Question 5

What are some of the common drug to food interactions ?

Answer 5

1. Bananas,oranges, green leafy vegetables (K+-rich) – Interacts with: ACEIs, ARBs, K-sparing diuretics
2. Apples, chickpeas, spinach, nuts, spinach, kiwi, broccoli (Vitamin E & K) Interacts with: Warfarin
3. Chicken, turkey, milk, soy,cheese, yogurt (alter PH) – Interacts with: Antibiotics, thyroid meds Digoxin, diuretics,
4. Grapefruit, Apple, Orange, & Cranberry (Cytochrome P450) – Interacts with: Statins, antihistamines

Question 6

What should you start prophylactically when putting an elderly person on an opiod?

Answer 6

Laxative - lactulose or senna

Question 7

What are some of the potential adverse effects of NSAIDs ?

Answer 7

• GI hemorrhage
• Decline in GFR (AKI)
• Decreased effectiveness of diuretics, anti-hypertensive agents
• Exacerbate CHF

Question 8

What are some of the common adverse effects of opiates and benzodiazepines ?

Answer 8

• impair psychomotor function
• falls
• confusion

Opiates can also cause - constipation, drowsiness, resp depression, delirium

Question 9

What are some of the potential adverse effects of antibiotics ?

Answer 9

Resistance and C.diff diarrhoea

Use only when objective evidence of infection (+ve blood culture,urine culture, pyrexia, consolidation on CXR

Question 10

What do you need to fill out when a patient has an adverse drug reaction ?

Answer 10

Yellow card scheme

Question 11

What are some of the potential problems with adherance to medications in the elderly?

Answer 11

• Can they open the pill container
• Do they understand when and how to take it
• Are they remembering to take their medications

Question 12

What are some of the common drug to drug interactions ?