Drugs in health and disease 2

Question 1

What is the risk of giving warfarin and ibuprofen?

Answer 1

Increased bleeding risk

Question 2

Why is drug absorption decreased and steady state time increased in the elderly?

Answer 2

Reduced saliva
Reduced gastric acid
Decreased GI motility
Reduced surface area for absorption
Reduced splanchnic blood flow

Question 3

What is volume of distribution?

Answer 3

Hypothetical volume obtained if all drug was in blood

Question 4

What is the equation of volume of distribution?

Answer 4

Vd = (amount of drug in body) / (concentration in plasma)

Question 5

What does volume of distribution affect?

Answer 5

Half life and duration of effect

Question 6

Why does drug distribution differ in the elderly?

Answer 6

Decreased lean body mass
Increased body fat
Decreased body of water
Albumin decreased

Question 7

What is the consequence of decreased lean body mass?

Answer 7

Decreased volume of distribution for drugs that distribute into muscles
Increased plasma concentration

Question 8

What is the consequence of increased body fat?

Answer 8

Increased volume of distribution for fat soluble drugs

Increased half life

Question 9

What is the consequence of decreased body of water?

Answer 9

Decreased volume of distribution of water-soluble drugs
Increased plasma concentration
Loading doses are lower

Question 10

What further decreases albumin?

Answer 10

Heart failure
Renal disease
Rheumatoid arthritis
Hepatic cirrhosis
Malignancies

Question 11

What drugs does decreased albumin affect?

Answer 11

Phenytoin
Warfarin
Propanolol
Diazepam
Levothyroxine
Digoxin
Furosemide

Question 12

What are the cardiac signs of digoxin toxicity?

Answer 12

Heart block
Bradycardia
Junctional tachycardia

Question 13

What are the psychiatric signs of digoxin toxicity?

Answer 13

Delirium
Fatigue
Malaise
Confusion
Dizziness

Question 14

What are the visual signs of digoxin toxicity?

Answer 14

Blurred or yellow-green vision
Halos
Double vision
Photophobia

Question 15

What are the gastrointestinal signs of digoxin toxicity?

Answer 15

Nausea
Vomiting
Anorexia
Diarrhoea
Abdominal pain

Question 16

What size effects can benzodiazepine cause?

Answer 16

Drowsiness
Confusion
Ataxia

Question 17

What is used to treat benzodiazepine overdose?

Answer 17

IV flumazenil 200mcg

Question 18

What are the signs of phenytoin toxicity?

Answer 18

Nausea and vomiting
Tremor
Ataxia
Nystagmus
Coarse facies
Hepatitis

Question 19

How do warfarin and aspirin interact?

Answer 19

Warfarin is highly bound to plasma albumin
Warfarin has a narrow therapeutic index and small volume of distribution
Aspirin can displace warfarin from plasma albumin increases concentration of warfarin

Question 20

What are the adverse effects of aspirin?

Answer 20

Peptic ulcer disease
Bleeding tendency
Fluid retention
Renal failure

Question 21

How does liver metabolism differ in the elderly?

Answer 21

Decreased liver volume
Decreased liver blood flow
Decreased first pass metabolism
Decreased enzyme activity CP450

Question 22

What drugs can be affected by CP450?

Answer 22

Antidepressants
Antipsychotics
Beta blockers
Opiates
Benzodiazepines
Calcium channel blockers
Theophylline
Warfarin
Phenytoin
NSAIDs
Paracetamol
Erythromycin

Question 23

How does excretion differ in the elderly?

Answer 23

Decreased renal mass
Decreased renal function
Half life increases

Question 24

Give examples of drugs that are primarily excreted by the kidneys?

Answer 24

Digoxin
Atenolol
Sotalol
Lithium
Allopurinol
Many antibiotics

Question 25

What are the implications of reduced excretion for prescribing?

Answer 25

Reduce dosage in OD preps | Increase dose interval in more frequently administered drugs

Question 26

What are the signs of early lithium toxicity?

Answer 26

Tremor Agitation Twitching

Question 27

What are the signs of intermediate lithium toxicity?

Answer 27

Lethargy

Question 28

What are the signs of late lithium toxicity?

Answer 28

Coma Fits Arrhythmias Renal failure

Question 29

What are the signs of morphine toxicity?

Answer 29

``` Nausea and vomiting Constipation Drowsiness Respiratory depression Hypotension ```

Question 30

How to treat morphine toxicity?

Answer 30

Naloxone IV 400mcg

Question 31

Why is there is a progressive decline in homeostatic mechanisms for pharmacodynamics in the elderly?

Answer 31

? due to receptor affinity or number ? alterations in 2nd messenger function ? alterations in cellular and nuclear responses

Question 32

Give examples of drugs that have increased effects in the elderly

Answer 32

``` Alcohol Benzodiazepines Warfarin Hypotensives GI effects of NSAIDs Central effects of anticholinergics ```

Question 33

Give examples of drugs that have decreased effects in the elderly

Answer 33

Beta1 modulators in cardiac tissue Reduced bronchodilators response to beta agonists CCB effect on PR interval decreased

Question 34

What are the side effects of ACE inhibitors?

Answer 34

Hypotension Hyperkalaemia Renal failure Cough

Question 35

What are the side effects of beta blockers?

Answer 35

``` Hypotension Confusion Bradycardia Lethargy Impotence ```

Question 36

What are the side effects of calcium channel blockers?

Answer 36

Hypotension Negatively inotropic Fluid retention

Question 37

What are the side effects of diuretics?

Answer 37

``` Hypotension Hypokalaemia Hyponatraemia Confusion Dehydration ```

Question 38

What are the side effects of haloperidol?

Answer 38

``` Confusion Sedation Parkinsonism Tardive dyskinesia Neuroleptic malignant syndrome ```

Question 39

Why might compliance be lower in the elderly?

Answer 39

Cognitive problems Manual dexterity Visual problems Dysphagia

Question 40

What adverse drug reactions can steroids cause?

Answer 40

Osteoporosis Gastric irritation / ulcers Hyperglycaemia

Question 41

What adverse drug reactions can tricyclic antidepressants cause?

Answer 41

``` Cardiac arrhythmias Drowsiness Dry mouth Constipation Urinary retention ```

Question 42

What adverse drug reactions can NSAIDs cause?

Answer 42

Renal failure Gastric irritation Fluid retention

Question 43

What adverse drug reactions can alpha blockers cause?

Answer 43

Drowsiness Hypotension Syncope Selective alpha blockers can cause urinary retention