Drugs and polypharmacy Flashcards

1
Q

4th leading cause of death

A

ADRI’S

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2
Q

Common iatrogenic drug problems (4)

A

Confusion, dry mouth, constipation, blurred vision, urinary retention

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3
Q

What can anticholinergics cause?

A

orthostatic hypotension

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4
Q

confusion and an unsteady gate can be caused by?

A

tricyclics and narcotics

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5
Q

you can have digoxin toxicity with?

A

normal serum concentrations

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6
Q

CNS toxicity can be caused by?

A

benzodiazepines

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7
Q

Costly medication-related problems/ADRs in older patients?

A
  • Falls
  • Cognitive Loss /delirium
  • Dehydration
  • Incontinence
  • Depression
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8
Q

End result of ARDI’s (3)

A

Loss of functional capacity
Poor quality of life
Nursing home placement

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9
Q

why do elders tend to have more prescriptions (some examples)

A
  • More acute & chronic disease
  • More doctors visits
  • Drugs often given to counteract a side effect of another drug
  • Several other factors arising from prescribers, patients and the system
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10
Q

Adverse drug reactions look like “growing old” - wha side effects to ADRs can often be dismissed ?

A
Unsteadiness
Dizziness
Confusion
Nervousness
Fatigue
Insomnia
Drowsiness
Falls
Depression
Incontinence
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11
Q

Prescribing Cascade

A

Drug 1
- ADE interpreted as new medical condition

Drug 2
- ADE interpreted as new medical condition

Drug 3

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12
Q

how may an elder present with Hyperthyroidism

A
  • Depression
  • Cognitive impairment
  • Muscle weakness
  • Atrial fibrillation
  • Heart failure
  • Angina
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13
Q

how may a younger patient present with Hyperthyroidism? (4)

A

Tremor
Anxiety
Weight loss
Diarrhoea

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14
Q

Healthcare provider factors thatcontribute to polypharmacy? think of some examples

A
  • Presumes that patient expects meds
  • Prescribes without sufficiently investigating clinical situation
  • No med review with patient on regular basis

-

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15
Q

absorption is not affected by?

it is affected by? why is this

A

age

  • rate of absorption is increased with age
  • GI transit time slows
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16
Q

a reduction in saliva production may result in?

A

a reduction in the rate of absorption of buccally administered drugs e.g. glyceryl trinitrate (GTN)

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17
Q

distribution - what changes in the body as you get older (4)

A
  • Reduced muscle mass
  • Increased adipose tissue
  • protein binding changes
  • Increased permeability across the blood-brain barrier
18
Q

distribution - fat soluble drugs

A

↑ Vd, ↑ T1/2, ↑ duration of action e.g. diazepam

19
Q

distribution - water soluble drug?

A

↓Vd, ↑ serum levels e.g. digoxin, furosemide

20
Q

distribution -protein binding changes

A

Decreased albumin

↓ binding, ↑ serum levels acidic drugs e.g. furosemide

21
Q

what is hepatic metabolism affected by?

A
  • Decreased liver mass

- Decreased liver blood flow

22
Q

consequences of hepatic metabolism

A
  • Toxicity due to reduced metabolism/excretion
  • Reduced first pass metabolism
    ↑ in bioavailability with some drugs e.g. propranolol
    Can cause ↓ bioavailability of pro-drugs e.g. enalapril
23
Q

what function decreases with age affecting excretion

A

Renal function

24
Q

excretion affect with age? - what does it ultimately lead to?

A

Reduces clearance and increases half-life of many drugs leading to toxicity

25
increased sensitivity to particular medicines - why is this? (3)
change in receptor binding, decrease in receptor number, altered translation of a receptor initiated cellular response into a biochemical reaction.
26
Give examples of drugs that have increased sensitivity (2)
diazepam (↑ sedation), warfarin (↑ anti-coagulation)
27
what criteria/ prescribing tools can we use? (3)
Beers’ criteria List of ‘inappropriate’ drugs for older people Updated occasionally but many weaknesses - START-STOPP criteria (O’Mahony et al) Advice on medical optimisation A lot to remember, so mostly research tool NHS Scotland Polypharmacy Guidance
28
why may you discontinue a drug? (many options)
- Adverse drug reaction - Drug-drug interaction - Drug-disease interaction - Better alternative - Not effective - Not indicated - Not evidence-based - Minimise polypharmacy
29
Some evidence that it is safe and/or beneficial to stop ? (3)
antihypertensives, benzodiazepines, antipsychotics
30
worst drugs for polypharmacy?
1. NSAIDs 2. Diuretics         3. Warfarin   4. ACEI 5. Antidepressants 6. Beta blockers                7. opiates 8. Digoxin 9. Prednisolone 10. Clopidogrel    
31
most adverse events in polypharmacy is in what 2 drug groups?
Anticholinergics | Sedatives
32
Common antimuscarinic effects - PERIPHERAL
- DRY EYES - DRY MOUTH - CONSTIPATION - REDUCED PERISTALSIS
33
Common antimuscarinic effects - CENTRAL
- MEM IMPARIMENT - CONFUSION - DISORIENTATION - DELIRIUM - FALLS
34
Sedatives are problematic | - WHY
Increased effects of benzodiazepines | Falls, confusion
35
Anti-psychotics - effects
Increased adverse effects | Postural hypotension, stroke, confusion, movement disorders
36
Analgesia - opioids are more ..?
More sensitive to effects, lower doses needed | Pethidine and tramadol may be less useful
37
NSAIDs - effect (2)
Renal impairment | GI bleeding
38
Digoxin - 2 things
Increased toxicity | Lower doses needed
39
Diuretics - effect?
Decreased peak effect, but reduced clearance Abnormal urea and electrolytes Other issues around continence and mobility Often inappropriate indication (swollen legs)
40
Anti-hypertensives effects? (4)
May have exaggerated effects on BP and HR - postural hypertension - ACEI = prodrugs = not metabolised to active form - Renal adverse effects
41
Anti-coagulants are more sensitive to?
to warfarin | Greater risk from warfarin i.e. GI bleeding, falls
42
side effects of antibiotics?
- Diarrhoea and c. diff infection - Blood dyscrasias (trimethoprim, co-trimoxazole) - Delirium (quinolones) - Seizures - Renal impairment (aminoglycosides)