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Year 1 Locomotion > Drugs in the elderly > Flashcards

Drugs in the elderly Flashcards

1
Q

Define Pharmacodynamics

A

How a drug alters the body

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2
Q

Define Pharmacokinetics

A

How the body alters the drug

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3
Q

Define polypharmacy

A

When the patient is taking 4 or more medications

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4
Q

What is an adverse drug reaction?

A

An injury caused by taking a medication

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5
Q

Name 2 risk factors associated with adverse drug reactions

A

Polypharmacy

Inappropriate prescribing

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6
Q

Name the 3 factors related to adverse drug reactions

A

DoTS classification

Dose

Time course

Susceptibility

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7
Q

What is the name for a reaction occurring below the therapeutic range?

Give an example of a drug where this may occur.

What would you do if this did occur?

A

Hyper-susceptibility

Penicillin

Completely avoid the drug permanently

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8
Q

What is the name for a reaction occurring within the therapeutic range?

Give an example of a drug where this may occur.

What would you do if this did occur?

A

Collateral

Antihistamines cause drowsiness

Nothing normally, as minimal and manageable side effects would be outweighed by the benefits of taking the drug - unavoidable

May not be reduced without reducing the therapeutic effect, even by reducing the dose

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9
Q

What is the name for a reaction occurring above the therapeutic range?

Give an example of a drug where this may occur.

What would you do if this did occur?

A

Toxic

Bleeding caused by Warfrin

Treat by reducing the dose being given

Prevent by using the minimal effective dose

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10
Q

Name 6 factors that have a effect on a patients susceptibility to a drug

A

Age - Old and young are more susceptible

Disease state - hepatic/renal impairment

Physiological state - pregnancy

Genetic susceptibility - Ethnicity

Sex

Exogenous factors - drug interactions/diet

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11
Q

Name 7 factors leading to increased drug reactions in the elderly

A

Decreased organ function

Co-morbidity

Poly-pharmacy

Altered Pharmacokinetics (moving substances through the body)

Altered Pharmacodynamics (receptor sensitivity/decrease in hormones)

Decreased homeostatic function

Decreased compliance

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12
Q

Name 3 things that should be carried out to achieve safe prescribing in the elderly

A

Improved compliance

(Simplify, educate, monitor) (Blister packs)

De-prescribe

(Discontinue drugs that aren’t of benefit/have adverse effects that require additional drugs to alleviate)

Medication reviews

(>75yo = annual reviews, and 6 month reviews if >75 yo and poly-pharmacy)

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13
Q

A reaction occurs immediately on taking a drug, what name is given to this?

Give an example of a drug that may cause this

A

First dose reaction

Ramapril causes hypertension (ACEi)

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14
Q

A reaction occurs 2 weeks into taking a drug, what name is given to this?

Give an example of a drug that may cause this and the action that should be taken.

A

Early reaction

Nitrates cause headaches

Patients may become tolerant to these reactions

ADR should wear off, so continue with medication

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15
Q

A reaction occurs 1 month into taking a drug, what name is given to this?

Give an example of a drug that may cause this and the action that should be taken.

A

Intermediate reaction

Neutropenia due to carbimazole

If no reaction occurs within a specific time frame then vigilance can be relaxed

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16
Q

A reaction occurs AFTER one month of taking a drug, what name is given to this?

A

Late reaction

Bruising due to corticosteroids

Risk of ADR increases with increased exposure

Need for long term monitoring

17
Q

If a drug is stopped at 2 months, and a reaction occurs a week after this, what is this reaction called?

A

Withdrawal

SSRI anti-depression discontinuation

Slow withdrawal or reduction of dose to prevent

18
Q

If a drug is stopped at 2 months, and a reaction occurs a month after this, what is this reaction called?

A

Delayed reaction

Carcinogenisis/teratogenesis

Avoid use of drug in patients that are susceptible

19
Q

Roughly, how many older people take at least 1 medication

A

4 in 5

20
Q

What percentage of the elderly take 4 or more medications

A

36%

21
Q

Elderly people are 3 times more likely to suffer from adverse drug reactions.

What percentage of hospital admissions are due to this?

A

5-12%

22
Q

What percentage of older patients do not take their medicines and prescribed?

A

Up to 50%

23
Q

What is a drug interaction?

A

A situation in which a substance affects the activity of a drug when both are administered together

24
Q

What is the normal therapeutic range for a drug?

A

1-1.5mg

25
Q

How do you report suspected severe drug reactions?

A

The yellow card scheme

26
Q

What is ageing?

A

Gradual loss of function of cells and organs with the eventual outcome of death

27
Q

Name 5 factors that influence ageing

A

Genetics

Psychology

Lifestyle (diet/exercise)

Socio-economic factors

Environment

28
Q

What are the 4 main pharmacokinetic processes?

How do these relate to the older population?

A

ADME

Absorption

Swallowing/gastric emptying/intestinal motility/blood flow/surface area

Distribution

Tissue perfusion an blood flow/plasma protein binding/volume distribution

Metabolism

Hepatic mass decrease/hepatic blood flow decrease/thyroid function decrease/genetics

Excretion

Assumption most older people have some degree of renal impairment.

Renal blood flow decreases, and GFR decreases

29
Q

Give 3 aging changes that occur in pharmacodynamics

A

Changes in receptor sensitivity (B-adrenoceptor sensitivity decreases with age)

Changes in receptor number

Changes in hormone levels (menopause)

30
Q

Give 7 common drugs that

A

ACE inhibitors

Diazepam

Digoxin

NSAIDS

Opiates

Oral hypoglycaemics

Warfrin

31
Q

Give 3 ageing changes in homeostasis

A

Decreased postural control

Decreased thermo-regulation

Decreased immune response

32
Q

Why does multi-morbidities increase the chance of adverse drug reactions?

A

More drugs needed so more chance of drug-drug interactions

More chance of drug-disease interactions

(Benzodiazepines may precipitate delirium in a patient with dementia)

33
Q

How much of the drug budget do older people take up?

A

40%

34
Q

What percentage of over 65’s are on regular medication?

A

66.6%

35
Q

Why can polypharmacy be a problem?

A

Loss of patient compliance (50%)

Prescription errors (5-20%)

Increased ADR’s and interactions

Inappropriate prescribing

36
Q
A

Year 1 Locomotion (18 decks)

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