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Geriatrics > Drugs + Polypharmacy > Flashcards

Drugs + Polypharmacy Flashcards

1
Q

How is absorption affected in elderly

A

Rate affected but not extent

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2
Q

How is distribution affected

A

Reduced muscle mass
Increased adipose so increased fat soluble drugs
Reduced body water so reduced water soluble drugs
Decreased albumin so increased free drugs
Increased permeability across BBB

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3
Q

How is metabolism affected

A

Decreased hepatic metabolism as decreased liver mass and blood flow
So drugs metabolised slower and stay in body

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4
Q

How is excretion affected

A

Renal function decreases so reduced clearance and increased half life
If renal affected use hepatic metabolised drugs etc

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5
Q

What are the pharmacodynamic effects due to age

A

Increased sensitivity to medicine - diazepam and warfarin have increased effects
Change in binding
Decreased receptor numbers so different effects
Altered translation of cellular response so increased

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6
Q

What help is there for drug dosage in elderly

A 
BNF
Schedule of product characterisitcs
Beer's criteria = inappropriate drugs
START-STOP 
NHS Scotland Polypharmacy Guidance
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7
Q

Issues with anti-psychotics

A

Hypotension
Stroke / TIA
Confusion
Movement disorder - Parkinsonism as dopamine antagonist

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8
Q

Issues with sedatives (Benz anxiolytic)

A

Falls
Postural hypo
Confusion
ADR

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9
Q

Issues with opioids

A 
More sensitive so lower dose
Constipation - prescribe laxative, may precipitate delerium 
Renal 
Confusion 
Falls
Hallucination 
Resp depression
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10
Q

Issues with NSAID / steroid

A

Increased adverse
Renal + bleeding
Peptic ulcer
CI asthma / renal failure

Not recommended >2 weeks without gastric protection / not recommended >65

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11
Q

Issues with digoxin

A

Increased toxicity so lower dose
Arrhythmia
Vomiting

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12
Q

Issues with diuretics

A 
Reduced clearance so abnormal U+E's 
Continence issue 
Hypokalaemia 
Falls 
Postural hypo 
Often used inappropriately e.g. swollen legs (should bel last resort)
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13
Q

Issues with anti-hypertensives

A

Increased effect on BP and HR
Postural hypotension
Falls and mortality
Renal failure

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14
Q

Issues with anti-coagulant

A

More sensitive to warfarin

Greater risk of bleeding and falls

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15
Q

Issues with antibiotics

A 
Increased adverse effects 
Delerium
Seizure
Renal
C.diff 
Deaf + renal in gentamicin
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16
Q

What are drugs commonly involved in ADR

A 
NSAID
DIuretic
Warfarin
ACEI
Anti-depressant
BB
Opiates
Digoxin
Prednisolone
Clopidogrel
Anticholinergic + sedatives = major
17
Q

How does ADR in elderly present

A 
Often 'growing old' symptoms so more drugs prescribed 
Falls 
Delerium
Dehydration
Incontinence
Depression
18
Q

Why polypharmacy?

A 
Acute and chronic disease
No review
Different doctors
Drugs to counteract side effects
ADR treated
19
Q

Issues with anticholinergics

A 
Postural hypo / dizzy 
Falls
Confusion and delirium 
Cognition
Retention - urinary and bowel so CI if BPE 
Constipation 
Blurred vision
Tachycardia 
Dry eyes and dry mouth as cholinergic receptors here

CI BPE / glaucoma/. MG

20
Q

Issues with cholinesterase inhibitors - used in dementia

A 
N+V+D
Fatique 
Insomnia
Cramps 
Headache 
Syncope / fall
21
Q

Common drugs in the elderly

A 
Diuretics
Analgesia
Hypnotics / sedatives / anxiolytics
Anti-hypertensive
Anti-psychotics 
Anti-rheumatic
BB
Digoxin
22
Q

Why ADR important in elderly

A 
Altered pharmacodynamics / kinetics
Increased sensitivity 
Potential drug interactions 
Polypharmacy 
Compliance - may take more if ill as think will help or less as forget
23
Q

What should you do when prescribing

A 
As few as necessary
Review 
Decreased dose and go slow 
Close monitoring 
Alert if new symptoms when prescribed 
Think if develop symptoms and just started on drugs
24
Q

What issue with hypoglycaemia

A

DOn’t need as tight control in elderly of DM as complications already arisen

25
Q

Examples of anti-cholinergic drugs

A 
Anti-muscarininc
Furosemide
Anti-histamine
CLozapine
Warfarin 
Ranitidine 
TCA - amitriptyline (confusion)
26
Q

What should you do with drugs

A

STOP if don’t need / likely to be causing delirium

27
Q

What does gentamicin cause

A

Renal failure

Hearing loss

28
Q

What is polypharmacy

A

> 4 drugs

29
Q

What should you always think

A

Is drug renal or liver cleared

30
Q

What drugs cause postural hypo

A 
Anti-hypertensive- ACEI/ BB
Diuretic
Nitrates
Hypoglycaemia agent
Anti-cholinergic
Anti-depressant
L-dopa
31
Q

What drugs cause falls for other reason

A 
Sedative / benzo
Anti-psychotic
Opiates
Anti-convulsant 
Digoxin
32
Q

What are very dangerous drugs in the elderly

A

Ibuprofen

Ramipril

Geriatrics (8 decks)

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