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Geriatrics > Drugs and polypharmacy > Flashcards

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
Q

increased sensitivity to particular medicines - why is this? (3)

A

change in receptor binding,
decrease in receptor number,
altered translation of a receptor initiated cellular response into a biochemical reaction.

26
Q

Give examples of drugs that have increased sensitivity (2)

A

diazepam (↑ sedation), warfarin (↑ anti-coagulation)

27
Q

what criteria/ prescribing tools can we use? (3)

A

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
Q

why may you discontinue a drug? (many options)

A
  • Adverse drug reaction
  • Drug-drug interaction
  • Drug-disease interaction
  • Better alternative
  • Not effective
  • Not indicated
  • Not evidence-based
  • Minimise polypharmacy
29
Q

Some evidence that it is safe and/or beneficial to stop ? (3)

A

antihypertensives, benzodiazepines, antipsychotics

30
Q

worst drugs for polypharmacy?

A
  1. NSAIDs
  2. Diuretics
  3. Warfarin
  4. ACEI
  5. Antidepressants
  6. Beta blockers
  7. opiates
  8. Digoxin
  9. Prednisolone
  10. Clopidogrel
31
Q

most adverse events in polypharmacy is in what 2 drug groups?

A

Anticholinergics

Sedatives

32
Q

Common antimuscarinic effects - PERIPHERAL

A
  • DRY EYES
  • DRY MOUTH
  • CONSTIPATION
  • REDUCED PERISTALSIS
33
Q

Common antimuscarinic effects - CENTRAL

A
  • MEM IMPARIMENT
  • CONFUSION
  • DISORIENTATION
  • DELIRIUM
  • FALLS
34
Q

Sedatives are problematic

- WHY

A

Increased effects of benzodiazepines

Falls, confusion

35
Q

Anti-psychotics - effects

A

Increased adverse effects

Postural hypotension, stroke, confusion, movement disorders

36
Q

Analgesia - opioids are more ..?

A

More sensitive to effects, lower doses needed

Pethidine and tramadol may be less useful

37
Q

NSAIDs - effect (2)

A

Renal impairment

GI bleeding

38
Q

Digoxin - 2 things

A

Increased toxicity

Lower doses needed

39
Q

Diuretics - effect?

A

Decreased peak effect, but reduced clearance

Abnormal urea and electrolytes
Other issues around continence and mobility
Often inappropriate indication (swollen legs)

40
Q

Anti-hypertensives effects? (4)

A

May have exaggerated effects on BP and HR

  • postural hypertension
  • ACEI = prodrugs = not metabolised to active form
  • Renal adverse effects
41
Q

Anti-coagulants are more sensitive to?

A

to warfarin

Greater risk from warfarin i.e. GI bleeding, falls

42
Q

side effects of antibiotics?

A
  • Diarrhoea and c. diff infection
  • Blood dyscrasias (trimethoprim, co-trimoxazole)
  • Delirium (quinolones)
  • Seizures
  • Renal impairment (aminoglycosides)

Geriatrics (10 decks)

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