Drugs and Polypharmacy

Question 1

prescribing tools available to help with prescribing in the elderly

Answer 1

BND, NHS Scotland Polypharmacy Guidance, STOPP/START criteria and Beers’ criteria

Question 2

name 4 drugs classess commonly implicated in ADRs

Answer 2

anticholinergics, benzodiazepines, NSAIDs and diuretics

Question 3

what fat soluble drug is different in elderly

Answer 3

diazepam - increasd half-life and Vd

Question 4

name a water soluble drug that is metabolised differently

Answer 4

atenolol - decreased Vd and higher serum levels

Question 5

changes in BBB

Answer 5

more permeable

Question 6

what kinds of drugs bind to albumin

Answer 6

acidic

Question 7

why is the 1st pass metabolism reduced

Answer 7

liver has reduced mass and blood flow

Question 8

what two drugs are affected by increasd sensitivtiy

Answer 8

warfarin and diazepam

Question 9

what antibiotics are most likely to cause delirium

Answer 9

quinolones

Question 10

principles of prescibing in elderly

Answer 10

• start low, go slow
• keep it simple
• don’t give another drug to treat an ADR
• review regularly and stop any non-benefitial meds
• consider compliance
• review whether the drug is achieving its aim

Question 11

what drug has a reduced rate of absorption and can commonly cause hypotension and falls

Answer 11

GTN - doesn’t releive angina so they have another spray and it hits them at once

Question 12

what is the advice for GTN use

Answer 12

spray –> if it doesn’t work, wait 5 minutes –> 2nd spray –> doesn’t go in 15 mins –> call ambulance

Question 13

name 5 drugs that will be metabolised differently

Answer 13

NSAIDs, atenolol, GTN, furosemide and sulphonylureas

Question 14

effect of stopping statins in later life

Answer 14

improve life expectancy