Drugs/Polypharmacy Flashcards
What problems may tricyclics cause?
Confusion
Unsteady gait
What problems may be caused by anticholinergics?
Confusion Dry mouth Constipation Blurred vision urinary retention Orthostatic hypotension
What kind of drugs may cause CNS toxicity?
Long-acting benzodiazepines
Why are ADRs sometimes not picked up on in older patients?
Look like growing old Unsteady Dizzy Confused Fatigue Drowsy Insomnia Falls Incontinence
How may body composition affect drug distribution?
Increased adipose tissue means greater absorption of fat soluble drugs and increase duration of action
Reduced body water means less absorption for water soluble drugs and increased serum levels
How might albumin affect drug distribution?
Decreased albumin means decreased binding and increased serum levels off acidic drugs like furosemide
How does age affect drug excretion?
Renal function decreases with age
Reduces clearance and increases half life leading to toxicity
What are the 2 main factors in hepatic metabolism?
Liver mass
Liver blood flow
What are some general principles of prescribing to older people?
Check if a lower dose is recommended in the elderly
Start at the lowest dose and titrate up slowly
Review new drugs and check if they’re effective
Review prescriptions regularly, stop any medicines that are not beneficial
Consider compliance issues
What criteria helps reduce ADRs and LoS?
STOPP/START criteria
What is deprescribing?
To reduce, substitute or discontinue a drug
How does age affect statin use?
Stop statins towards the end of life
Which drugs cause the most adverse events?
Anticholinergics
Sedatives
How do sedatives affect benzodiazepines?
Increase effect of them leading to falls and confusion
What kind of antibiotic may lead to delirium in polypharmacy?
Quinolones
