Elderly - 1 Flashcards
Principles that reduce drug-related morbidity & mortality
- Only when absolutely needed, use drug.
-Avoid, if possible, a1-adrenoceptor blockers, drugs with anticholinergic effects, very sedative or long half-life or inhibitors of hepatic metab. enzymes
-start low, and go slow
-Don’t treat S.E with another drug
-Keep therapy simple (one dose between than BID)
Covert use of medicine (in foodstuff) in dementia allowed only …
full discussion with MDT
recording
only if in patients benefit
does the literature support the use of ginkgo Biloba in cognitive impairment and dementia…
Not much.
But it is safe.
What is Huperzine A?
an alkaloid isolated from the chinese her huperzia serrata
Highly selective, reversible ACHE-I
literature on Huperzin A for AD?
a meta-analysis showed it led to significant. improvement on MMSE and ADL
Later, this result were replicated
literature on Efficacy of saffron (crocus sativus) in AD
supported by meta-analysis and systematic review
on adas-cog and other scales
which new parental treatment is under investigation for vascular dementia?
Cerebrolysin
what is cerebrolysin?
porcine brain-derived peptide preparation that has pharmacodynamic properties similar to those of endogenous neurotrophic factors.
——— consumption is shown in longitudinal studies to be assocaited with lower risk of cognitive impairment (adjusted for confounders). (moreira et al 2016)
Chocolate
% of completed suicides that occur in elderly?
20%
What do meta-analysis say about elderly response to antidepression compared to younger adult?
51%
Similar
(MPGIP 14th)
Most toxic TCAs in elderly
Doxepin
Amitriptyline
(Seizure and cardiac arrhythmia)
Toxic effects of TCA in elderly?
Seizure and cardiac arrhythmia
(Doxepin & Amitriptyline)
Possible exception to general safety of SSRIs in elderly?
Citalopram
(minor metabolite can cause QTc- prolongation)
SSRIs that can cause weight gain in elderly
Paroxetine
Citalopram
Most sedative SSRI in elderly?
Paroxetine
Fluvaxamine
antidepressant class that can cause interstitial lung diseases?
SNRIs
What antidepressant can cause cognitive impairment in elderly that begins with T
Trazodone
NaSSa class antidepressant that cause problematic weight gain in elderly?
Mirtazapine
Is there an ideal antidepressant for the elderly ?
nope
Older people are particularly prone to develop 1- ———— 2————– 3———– and 4 ———due to SSRIs.
1- Fall
2- Postural hypotension
3- Hyponatraemia
4- Haemorhagic stroke
Ranking of antidepressant safety and tolerability in the elderly?
- SSRIs (watch out for GI bleeding in hx of bleeding, NSAIDs, warfarin)
-Agomelatine ( watch out for LFT)
-Vortioxetine & Duloxetine for those not suitable for SSRIs due to their caveats
1st line treatment for behavioural and psychological symptoms of dementia (BPSD) in the elderly (MPGIP 14th)
Evidence-based, multicomponent non-drug measures, which are personalised and involve working closely with care-givers
example of 1 evidence based non pharma therapy for behavioural and psychological symptoms of dementia (BPSD)
music therapy (MPGIP 14th)
what are Multicomponent interventions
They use a comprehensive, integrated multidisciplinary approach combining medical, psychiatric and nursing interventions may be more effective at reducing severe behavioural problems in nursing home patients.
The antipsychotic that is licensed for persistent aggression in AD
Risperidone
True or false
Antipsychotics should not be used routinely to treat agitation and aggression in people with dementia.
True
when can analgesics be used for aggression & agitation in dementia?
when there is a complete assessment of pain
Following up the effectiveness
Usually choose paracetamol (worth a trial even in overt pain)
which FGA is not recommended in BPSD
Haloperidol
Regime for Risperidone in BPSD ?
Dose range: 0.25–2mg/day
Reduce by 0.25–0.5mg every 1–2 weeks (depending on dose), then stop
clinical benefit of AChE-Is and memantine in BPSD?
Unclear
studies suggest cholinesterase inhibitors are more effective for 1——–, 2——–, 3——– and 4——–symptoms.
depression
dysphoria
apathy
anxiety
SSRI with strongest evidence in a RCT for BPSD?
Citalopram?
The preferrable point about sertraline in comparison to citalopram?
it’s cardiac safety
Max dose of agomelatine in elderly
50 mg at night or evening
Min dose of agomelatonine in elderly
25 mg
max dose of citalopram in elderly
20 mg at morning
min dose of citalopram in elderly
10 mg at morning
melatonin max and min dose in elderly
2 mg prolonged release at night
