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Elderly > Elderly 1 > Flashcards

Elderly 1 Flashcards

1
Q

What happens to lipophilic drugs? Give examples for drugs

A

Inc. Vd & elimination t1/2 due to inc. fat= longer time to leave the body

E.g: diazepam - amitriptyline - valporic acid - amiodarone - verapamil

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2
Q

What happens to hydrophilic drugs/ give examples

A

Lower body water> high levels of drugs in body > need to dec. dose

E.g: aspirin - digoxin - morphine - lithium

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3
Q

What happens to highly protein bound drugs ? Examples

A

The serum albumin may or not change,
The drugs free fraction in plasma increases

E.g ; warfarin, phenytoin, diazepam

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4
Q

How dose the change in hepatic metabolism changes?

Give examples.

A

Inc. bioavailability dec. clearance inc. elimination t1/2

CVS: CCB, nitrates, statins, labetalol, propranolol, metoprolol

CNS: Levodopa, morphine, TCA

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5
Q

What happens to the 1st pass activation of prodrugs?

A

Might be slowed or decreased

E.g: ACEI (enalapril & perindopril) - clopidogrel

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6
Q

What happens to drug dependent on phase II rxn?

A

Relatively unaffected

E.g: lorazepam, oxazepam, temazepam, glipizide

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7
Q

What drugs to avoid if CrCL < 30mL/min?

A

Dabigatran - fondaparinux - spironolactone - duloxetine - tramadol ER - metformin

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8
Q

What drugs to reduce dose if CrCL < 30mL/min?

A

Ciprofloxacin- trimethoprim/sulfamethoxazole (avoid if < 15mL/min)
Enoxaparin, colchicine

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9
Q

What drugs to avoid if CrCL < 25 mL/min?

A

Apixaban

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10
Q

Digoxin criteria

A

Avoid if:

  • 1st line AFib/HFrEF
  • > 125mcg/day w/ impaied RF ( eGFR <50ml/min)
  • eGFR < 30 ml/min
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11
Q

Loop diuretic: furosemide criteria

A

Avoid in :

  • Ankle edema w/o evidence of HF, liver failure, nephrotic syndrome or CKD
  • 1st line monotherapy for HTN
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12
Q

Thiazide diurets : hydrochlorothiazide - Chlorthalidone - metolazone

A 
Avoid if:
sK < 3,0mmol/L
sNa < 130 mmmol/L 
Corrected sCa > 2.65 mmol/L 
History of gout 
Dose > 25mg (HCTZ, CT)
eCrCl <30ml/L (except metolazone)
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13
Q

Aldosterone antagonist

Spironolactone- eplerenone criteria

A

Avoid :
sK > 5mmol/L a&/or eCrCL < 30 mL/min

spiro dose > 25mg

Concurrent with : ACEI/ARB + k-sparing

Inc. risk of hyperkalemia

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14
Q

BB criteria

A 
Avoid in:
Combo w/NDHP CCB - risk of heart block 
Bradycardia- heart block/asystole
Diabetic- masking hypoglycemia symptoms 
Non-selective BB in asthma- bronchospasm
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15
Q

NHDP-CCB criteria :

A

Avoid:
with HFrEF - worsen HF
Constipation - Exacerbate
In combo with BB

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16
Q

CCB criteria:

A

Avoid immediate release CCB as they increase the risk of hypocrisy and precipitating MI

17
Q

Alpha-blocker criteria

A

Avoid as routine treatment for HTN - risk of OH

18
Q

Central a2 agonist: clonidine - methyldopa

A

Avoid as routine treatment for HTN as they inc. the risk of OH - adverse CNS effects - bradycardia

19
Q

Amiodarone criteria

A

Avoid as 1st line treatment for rate control in AFib UNLESS

Patient has HFeEF or rhythm control is preferred over rate control

20
Q

HF patient should avoid:

A
  • NDHP CCB (HFrEF)
  • Dronedarone
  • NSAIDs
  • Cilostazol
  • pioglitazone & rosiglitazone
  • saxagliptin
21
Q

Aspirin criteria

A 
Avoid:
- PMH of PUD w/o PPI
- > 160 mg/day (inc. risk of bleeding)
- combo w/OAC in ptnt w/ chronic AFib
Use w/caution in >70y/o CV protection
22
Q

OAC
Vit. K antagonist (warfarin)
Direct thrombin inhibitor (dabigatran)
Factor X inhibitor ( rivaroxaban - apixaban)

A
  • Dabi & riva : caution in >75 = inc. risk of bleeding
  • If the patient had 1st DVT or PE w/o continuing provoking RF
    Avoid OAC use for > 6 months (dvt) or >12 months (PE)
23
Q

What deugs to avoid in combo w/ Warfrain and why?

A

Avoid with
- trimethoprim-sulfamethoxazole/ ciprofloxacin / macrolides but azithro / MSAIDs

Reason :
Increase risk of bleeding - if used together monitor INR

24
Q

Antidepressants criteria

A 
Avoid TCA (amitriptyline - imipramine) SSRI (paroxetine - amoxapine) 
As they’re sedating - inc. risk of OH, falls/fracture- cognitive impairment - constipation - dry mouth - urinary retention
25
Q

What is START criteria in prescribing antidepressant/

A

Prescribed in presence of moderate to severe depressive symptoms lasting at least 3 months.

26
Q

What are the optimal choice of SSRI and when to avoid

A

Drugs: sertraline - citalopram - escitalopram - fluoxetine

Can cause hyponatremia avoid in current/recent sig. hyponatremia ( <130mmol/L in past 2 months)

citalopram - escitalopram risk of QT prolongation

27
Q

BDZ/barbiturates criteria

A
  • avoid for insomnia, agitation, delirium
  • MAY give for emergency seizure disorder- severe GAD - pre-procedural anesthesia- ethanol withdrawal

Note: if prescribed give short acting for no longer than 4 weeks

28
Q

Antipsychotics - typical and atypical

A

Typical:
Phenothiazines ( CPZ - thioridazine)
Butyrophenones (haloperidol- thioxanthenes (flupenthixol))

Atypical:
Risperidone - clozapine - olanzapine - quetiiapine - pimavaserin - aripiprazole

Elderly (1 decks)

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