Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 4 OPIC > Drugs used in old age/ Polypharmacy > Flashcards

Drugs used in old age/ Polypharmacy Flashcards

1
Q

What are the aims of alzheimers dementia treatment?

A

Promote independence, maintain function, manage symptoms, there is no cure

3 acetylcholinesterase inhibitors are recommended as first line for managing mild to moderate AD

Donepezil
Rivastigmine
Galantamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How do acetylcholinesterase inhibitors work?

A

The cholinergic hypothesis suggests that a dysfunction of neurones in the brain, containing the neurotransmitter acetylcholine significantly contributes to the cognitive decline seen in those with advanced age and alzheimers disease

Acetylcholinesterase inhibitors inhibit the enzyme acetylcholinesterase from breaking down acetylcholine into choline and acetate thereby increasing both the level and duration of action of the acetylcholine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How does memantine work? When is it used?

A

NMDA receptor agonist (glutamate receptor antagonist)
Recommended for patients with moderate AD who are intolerant or have a contraindication to acetylcholinesterase inhibitors or severe AD

Patients can now be started on memantine on top of their Acetylcholinesterase inhibitors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How do you treat lewy body dementia/parkinsons?

A

AChEi can be given, rivastigmine

VD optimise vascular risk factors- BP, DM, cholesterol etc

AChEi and memantine are not recommended in patients with frontotemporal dementia or cognitive impairment by MS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the cautions of anti choleresterases?

A 
Gastric/duodenal ulcers
Bladder obstruction 
Asthma
COPD
Heart block
Syncope 
Seizures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What should you be cautious of when giving memantine?

A

Epilepsy/ seizures

Max 10mg OD if eGFr <30

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the side effects of anti cholinesterases?

A

GI disturbance- reduced appetite, arrythmias, dizziness, drowsiness, falls, headache, GI bleed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the side effects of memantine??

A

ConstipationDizziness
Drowsiness
Headache
Seizures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is BPSD?

A

Behavioural and psychological symptoms of dementia
Very common- point prevelance is 60-80%
Cumulative risk >90% over the course of the illness
The number, type, severity of BPSD varies between patient

Symptoms- agitation, agression, wandering, sexual disinhibition, shouting out, sleep disturbance, depression, anxiety, hallcuinations and delusions, sundowning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the non pharmacological managements of BPSD?

A

ABC charts (date and time of behaviours, where, description of behaviour)
Nutrition
Hearing aids/glasses to compensate for sensory impairements
Reminscence therapy ie: life story books
Complimentary therapies (hand massage, aromatherapy, beauty therapies)
Risk assesment, reduction and intervention- are the patients needs being met
Psychological
Know about their life
Structure of days are important

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the general principles of pharmacological management of dementia?

A

Benefits must outweigh the any anticipated risks for the individual

If meds started, review in 6 weeks

Start low and go slow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What meds are used in BPSD?

A

Antidepressants- SSRIs, mirtazapine
For low mood and anxiety

AcheI / memantine for agitation in AD

Benzos- lorazepam

Analgesia- regular paracetamol or buprenorphine patch if indicated

Mood stabilisers/ anticonvulsants (depakote)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Are antipsychotics used in BPSD?

A

Not routinely, only if severe agitation

Risperidone is usually used

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Where do you find patients drugs?

A

MAR chart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are important parts of prescribing

A 
Tell nurses about once only dose
Write renal function on front
Allergies
Write micrograms or units in full 
Write insulin brand
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How to measure elderly patients clearance?

A

EGFR
(Age, gender, ethnicity, creatinine level)
Creatinine clearance

However this doesn’t take into account the patient’s size

MHRA recommend oral anticoags, nephrotoxic, extremes of muscle mass, and if they have nephrotoxic meds then use the calculated creatinine clearance (system one tool) affects Enoxaparin, apixaban

Cockcroft-Gault formula should be used to calculate creatinine clearance (CrCl).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the prescribing cascade?

A

The treatment of side effects of drugs as a new disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the side effects of anticholinergics?

A

Constipation
Blurred vision
Affect on heart
Increase cognitive impairement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What problems do elderly patients have taking tablets?

A
  • memory
  • not knowing when to take them
  • shaky
  • swallowing problems
  • don’t know why they are on them
  • reading labels
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What can be done to aid the elderly taking lots of drugs?

A

Blister packs
MAR chart- a chart that old people can tick off
Phone apps
Pharmacy Carousel
Give information Leaflets
Pharmacy’s can print larger labels for medications
Can try and switch them to less frequent tablets by giving them slow release ones

For big tablets- some can be crushed (some have protective gastro lining you can’t crush these ones)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How can you help old people use eye drops?

A

Opticare devices

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What class is Haloperidol?

A

1st generation antipsychotic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the indication for Haloperidol?

A

Delirium not treated by pharmalogical treatment
Post operative nausea and vomiting
Restlessness and confusion in palliative care

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What side effects of haloperidol is there?

A

Parkinsonism (bradykinesia, resting pinrolling tremor 4-6Hz, rigidity)

Hypersalivation

Angiooedema

Hypertension

Eye disorders

Headaches

Neuromuscular dysfunction

Nausea

Psychotic disorders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are the interactions of haloperidol?

A

Alcohol
Hypertensive meds- acebutolol/amlodipine/candesartan
Amitriptyline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Does haloperidol have an impact on falls?

A

Yes research indicates that antipsychotics are associated with increased fall risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What class is macrogol and what is it used for?

A

Osmotic laxative

It is used for chronic constipation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are the SEs of Macrogol?

A 
Flatulence 
GI 
Discomfort 
Nausea
Vomiting
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is alendronate, how does it work?

A

It is a bisphosphonate

It works by being adsorbed onto hydroxyapatite crystals in bone which slows their rate of growth and dissolution

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What are the side effects of alendroate?

A 
Alopecia 
Anaemia 
Arthralgia 
Constipation 
Diarrhoea 
Dizziness
Electrolyte imbalance 
Peripheral oedema 
RENAL IMPAIREMENT (shouldn’t use if the eGFR is <35mmol/l) 
GI disorders
Joint swelling 
Vertigo
31
Q

What is the indication of alendroate?

A

Treatment of postmenopausal osteoporosis
Prevention and treatment of corticosteroid induced osteoporosis in both men and women
Treatment of osteoporosis in men

32
Q

How should you advise someone to take bisphosphonates ie: alendronate…

A

Take whole with plenty of water
Can take either sitting or standing but must be sat upright or standing half an hour after
Take on an empty stomach, at least 30 mins before breakfast or another oral medicine

33
Q

What warning should you give a patient taking alendroate?

A

Atypical femoral fractures- patients should be advised to report any thigh, hip or groin pain during the treatment

Osteonecrosis of the jaw

Osteonecrosis of the external auditory canal

Also warn about symptoms of oesophageal irritation such as- dysphagia, new or worsening heartburn, pain on swallowing or retrosternal pain

34
Q

What medications does Alendroate interact with?

A

Antacids- these decrease the absorption of alendroate, alendroate should be taken 30 mins before antacids

Aspirin- increases gastrointestinal irritation

Calcium carbonnate/acetate- again should be taken 30 mins before

NSAIDS- increase GI irritation

35
Q

What is Adcal D3?

A

Chewable tablets

This is a combination of Vit D3 and Calcium carbonate

36
Q

What are the indications for Adcal D3?

A

Osteoporosis

Where body’s calcium and vit D levels need to be increased

37
Q

What are the side effects of Adcal D3?

A 
Constipation 
Nausea 
Abdominal pain 
Diarrhoea 
Hypercalcaemia
38
Q

What drugs should not be taken at the same time as Adcal D3?

A

Antacids- this might damage the enteric coatings which are designed to prevent dissolution in the stomach

39
Q

What is the class of strontium ranelate?

A

Strontium salt of ranelic acid

40
Q

What is the indication of strontium ranelate?

A

Used in the management of severe osteoporosis in high risk postmenopausal women and adult men

41
Q

What are the side effects of strontium ranelate?

A 
Hyperactivity 
Consciousness impaired
Angioedema
Arthralgia 
Bronchial hyperactivity 
Constipation 
Diarrhoea 
Dizziness
42
Q

What interacts with strontium ranelate?

A

Calcium! Avoid taking the same time as calcium rich foods or calcium supplements as this decreases the absorption

43
Q

What is colchicine and what is it used for?

A

An alkaloid which is used in the symptomatic relief of pain in attacks of gout
Short term prophylaxis during initial therapy with allopurinol

44
Q

What are the side effects of colchicine?

A

Common- abdo pain, diarrhoea, nausea, vomiting

Frequency not known- agranulocytosis, alopecia, bone marrow disorders, GI haemorrhage, Kidney injury, Liver injury

45
Q

What class is Allopurinol and what are the indications for it’s use?

A

Xanthine Oxidase inhibitor

1) management of patients with signs and symptoms of primary or secondary gout
2) the management of patients with leukaemia, lymphoma and malignancies who are receiving cancer therapy which causes elevations of serum and urinary uric acid levels

46
Q

What are the side effects of allopurinol?

A

Rash- common
Hypersensitivity, N and V- uncommon
Rare/very rare- agranulocytosis, alopecia, aplastic anaemia

47
Q

What cautions should you take with allopurinol?

A

Ensure adequate fluid intake (2-3L/day)
For hyperuricaemia associated with cancer therapy then allopurinol treatment should be started before cancer therapy
Thyroid disorders

48
Q

What class is prednisolone and what is it used for?

A 
Corticosteroid
Acute exacerbations of COPD 
Severe croup for kids
Mild to mod asthma 
UC/Crohn’s
49
Q

What are the side effects of prednisolone?

A 
Side effects- 
Anxiety 
Behaviour abnormal 
Cataract subscapular 
Cognitive impairment 
Cushing’s syndrome 
Electrolyte imbalance
Fatigue 
Fluid retention 
GI discomfort 
Headache 
Heeling impaired 
Hirsutism 
HYPERTENSION 
Increased risk of infection 
Menstrual cycle irregularities 
Mood altered 
Nausea 
Osteoporosis 
Peptic ulcer 
Psychotic disorder 
Skin reactions 
Sleep disorders
Weight increased
50
Q

In terms of prednisolone, what do you need to make the patient aware of in terms of adrenal suppression?

A

During prolonged therapy with corticosteroids, particularly with systemic use, adrenal atrophy can develop and persist for years after stopping

Abrupt withdrawal after a long period can lead to acute adrenal insufficiency, hypotension or death

To compensate for a diminished adrencortical response caused by prolonged corticosteroid treatment then any significant illness, trauma or surgical procedure requires a temporary increase in corticosteroid dose, or if already stopped, a temporary reintroduction of corticosteroid treatment

51
Q

What advice should you give in regards to infections and steroids?

A

Prolonged courses of corticosteroids increase susceptibility to infections and severity of infections

Clinical presentation of infections may also be atypical

Unless they have had chickenpox, patients are at risk of severe chickenpox (DIX/pneumonia/hepatitis, rash in not a prominent feature)

Confirmed chickenpox warrants specialist care and urgent treatment
Corticosteroids shouldn’t be stopped, doses may need to be increased

Measles- should take extra care to avoid exposure and IM normal immunoglobulin prophylaxis may be needed

52
Q

What should you advise in terms of psychiatric reactions when giving prednisolone?

A

Systemic corticosteroids- particularly in high doses are linked to psychiatric reactions including euphoria, insomnia, irritability, mood lability, suicidal thought, psychotic reactions and behavioural disturbances.

53
Q

What is pizotifen and what are some side effects?

A

It is a drug which is used in the prevention of vascular headache, prevention of classical migraine, prevention of common migraine, prevention of cluster headache

Side effects= appetite increased, dizziness, drowsiness, dry mouth, fatigue, nausea, weight increased

54
Q

What is zopiclone used for?

What are the side effects?

Why is zopiclone relevant in the elderly?

A

This is used for insomnia (short term use)

Side effects- dry mouth, taste bitter

For hypnotic z- drugs, prescription is potentially inappropriate (STOPP criteria) in elderly as may cause protracted daytime sedation and/or ataxia.

55
Q

What is Entacapone, how does it work, when is it given?

A

Entacapone prevents the peripheral breakdown of levodopa, by inhibiting catechol- O- methyltransferase, allowing more levodopa to reach the brain.

It is used as an addjunct to co-beneldopa or co-careldopa in Parkinsons disease with ‘end of dose’ motor fluctuations

56
Q

What are the side effects of entacapone?

A

Abdo pain

CONFUSION

Constipation

Diarrhoea

Dizziness

FALL

IHD

Etc

57
Q

What is ropinirole, what are the side effects?

Why is it relevant in terms of prescribing in old people?

A

This can be used alone or as an adjunct to co-beneldopa or co-careldopa

Can also be used in moderate to severe restless legs syndrome

The MOA is unkown, thought to be related to activated D2 receptors

Side effects….

Common- confusion, dizziness, drowsiness, fatigue, GI discomfort, hallucination, movement disorders, nausea, nervousness, peripheral oedema, sleep disorders, syncioe, vertigo, vomiting

In the elderly it can cause hypotension and severe cardiovascular disease- need to monitor the blood pressure

58
Q

What are the indications for Amitriptyline, should it be used in the elderly?

A

Used for multiple things;

  • Major depressive disorder
  • Neuropathic pain
  • Migraine prophylaxis
  • Chronic tension-type headache prophylaxis
  • Emotional lability in MS

Although it is a great drug for young people, it shouldn’t be used for the elderly as it can cause them to fall, they are also particularly susceptible to many of the side effects of TCAS…

  • Anticholinergic syndrome
  • Drowsiness
  • QT INTERVAL PROLONGATION

(shouldn’t be used in severe hepatic impairment)

59
Q

What are the symptoms/signs of anticholinergic syndrome?

A 
Fever 
Mydriasis
Tachycardia 
Hypertension 
Delirium 
Warm, dry skin 
Coma 
Ileus 
Urinary and gastric retention
60
Q

What are the symptoms/signs of serotonin syndrome?

A 
Fever 
Mydriasis 
Tachycardia 
Hyperkinesia 
Tremor 
Irritability 
Diaphoresis 
Diarrhoea 
Hyperreflexia
61
Q

What is co-beneldopa/co-careldopa?

A

They are the brand names for LEVODOPA used in parkinsons disease

They work by being converted to dopamine in the brain, by taking it as a drug treatment it boosts the supply, meaning the nerve cells can make more dopamine.

62
Q

What are the benefits of taking Levodopa?

A

Helps with bradykinesia and rigidity!

However they don’t prevent the disease progressing- dopamine producing cells are still being lost.

63
Q

What are the side effects of levodopa?

A

Involuntary movements- with long term use, the patient may experience involuntary movements (dyskinesia), these are muscle movements which the patient can’t control- twitches, jerks, writhing movements.

Impulsive and compulsive behaviours- gambling, shopaholic, binge eating, etc

Withdrawal syndrome- neruoleptic malignant syndrome, rhabdomyolysis

Anxiety, appetite decreased, arrythmia, depression, diarrhoea, hallucination, movement disorders, nausea, parkinsonism, postural hypotension, taste altered, vomiting

Can cause postural hypotension and therefore fall risk

64
Q

What are the indications for trimethoprim, is it appropriate in elderly?

A

Respiratory tract infections

Prophylaxis of recurrent UTI

Treatment of mild to moderate pneumocystis jirovecii

Acne resistant to other antibacterials

SE’s include: diarrhoea, electrolyte imbalance, fungal overgrowth, headache, nausea, skin reactions, vomiting

Should be used with caution in elderly

65
Q

What is tamsulosin used for, how does it work, what are the side effects, is it risky to use in the elderly?

A

It is an alpha1- selective adrenoceptor blocker

It is used for benign prostatic hyperplasia

Causes dizziness, sexual dysfunction
As it causes dizziness
Causes postural hypotension

STOPP criteria=

  • This is potentially inappropriate in the elderly
  • it is inappropriate with symptomatic orthostatic hypotension or micturition syncope (risk of precipitating recurrent syncope)
  • In those with persistent postural hypotension ie: recurrent drop in systolic blood pressure > or equal to 20mmhG (There is a risk of syncope and falls)
66
Q

What is oxybutynin hydrochloride used for?

What are the side effects?

A

It is a antimuscarinic

Urinary frequency
Urinary urgency
Urinary incontinence
Neurogenic bladder instability

Side effects=
Constipation, dizziness, drowsiness, dry mouth, dyspepsia, flushing, headache, nausea, palpitations, skin reactions, tachycardia, urinary disorders, vision disorders, vomiting

Can cause confusion in elderly

67
Q

When is oxybutynin hydrochloride potentially inappropriate in elderly?

A

STOPP criteria:
To treat extrapyramidal side effects- there is a risk of antimuscarinic toxicity

With delirium or dementia (risk of exacerbation of cognitive impairement)

Narrow angle glaucoma

Chronic prostatism (urinary retention)

If two or more antimuscarinic are prescribed concomitantly (risk of antimuscarinic toxicity)

68
Q

What is cinnarizine, what is it used for?

A

Cinnarizine is a calcium channel blocker and a antihistamine

It is used for relief of symptoms of vestibular disorders- vertigo, tinnitus,nausea and vomiting in menieres disease.

It can also be used in motion sickness in kids

69
Q

What are the side effects of cinnarizine and should it be used in the elderly?

A

Drowsiness
GI discomfort
Nausea
Weight increased

70
Q

What is baclofen, when is it used, what are the side effects, should it be used in the elderly?

A

It is a skeletal muscle relaxant
It it used for pain of muscle spasm in palliative care, hiccups due to gastric distension in palliative care, chronic severe spasticity from disorders like MS or traumatic partial section of the spinal cord

Can cause confusion, constipation, depression, diarrhoea, hYPOTENSION, dizziness, drowsiness, hallucination, vision disoders etc…

Should be used with caution in the elderly

71
Q

What is Digoxin, when it is used, what are the side effects, should it be used in the elderly?

A

It is a cardiac glycoside, that increases the force of myocardial contraction and reduces conductivity within the AV node

Used in AF/flutter
Heart failure for patients in sinus rythm
Used as a loading dose for AF or flutter

Side effects= Arrythmias, cardiac conduction disorder, cerebral impairement, diarrhoea, dizziness, eosinophilia, nausea, skin reactions, vision disorders, vomiting

Prescription is potentially inappropriate in elderly…
Stopp CRITERIA

Where it is being used for heart failure with normal systolic function there is no evidence of benefit

Where it is used at high dose in renal impairement eGFR <30mL/minute, this can lead to digoxin toxicity

72
Q

What is Doxasozin, when is it used, what are the side effects, should it be used in the elderly?

A

Doxasozin is an alpha blocker
It is used in hypertension/ BPH/

Can cause arrythmias, chest pain, cough, cystitis, drowsiness, dizziness, dry mouth

Needs to be used with caution in elderly due to the risk of postural hypotension and falls

73
Q

What is simvastatin, how does it work, what is it used for, side effects and should it be used in elderly?

A

Statin is a HMG-CoA reductase inhibitor, which is an enzyme involved in cholesterol synthesis, especially in the liver
Lipid lowering medication

Indications- Primary hypercholesterolaemia or combined hyperlipidaemia in patients who have not responded adequately to diet and other appropriate measures

Prevention of cardiovascular events in patients with atherosclerotic cardiovascular disease or diabetes mellitus

Need to be careful in renal impairement/hypothyroidism- increases risk of muscular toxicity

Side effects- asthenia, constipation, diarrhoea, dizziness, GI discomfort, headache, myalgia, nausea, sleep disorders, THROMBOCYTOPENIA

Year 4 OPIC (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions