Elderly - 2 Flashcards

1
Q

Most common reversible cause of delirium & dementia in elderly?

A

Medications

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2
Q

Drug class that have most association with dementia in elderly?

A

Opioids
Benzodiazepines
Anticholinergics

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3
Q

which one is more troublesome in elderly?

Short acting or long acting benzo?

A

Long acting

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4
Q

which neuroleptic have found in orthopedic RCT to have higherst RR for delirium in elderlyy ?

A

Haloperidol

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5
Q

How many folds opioids increase risk of delirium in elderly?

A

2 folds

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6
Q

which opioids has higherst risk of delirium in elderly?

A

Pethidine

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7
Q

why pethidine has higherst risk for delirium in elderly?

A

It accumulate.
Renal function declines
Its metabolite has anticholinergic

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8
Q

Antipsychotics with anticholinergic properties

A

Clozpaine, Chlorpromazine and Thioridazine = +++++

Olanzapine= +++

Loxapine and Quetiapine = ++

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9
Q

True or false

Newer antipsychotic have less anticholinergic effects

A

True

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10
Q

Mnemonic for Drugs that cause Mood change in elderly?

A

ACADI

A- Antidepressants —>mania
C- Corticosteroids —>depresssive, manic and mixed w/ or w/out psychosis
A-Antihypertensive (centrally actives)—> depression
D- Digoxin —>depression
I- Interferon—>depression

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11
Q

anti hypertesives that cause depression in elderly?

A

reserpine
methyldopa
clonidine

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12
Q

What does interferon -a is capable of in elderly?

A

induing depression

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13
Q

Medications linked to psychosis in elderly?

A

Anti parkinsons
Corticosteroids

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14
Q

which anti parkinson’s cause psychosis in elderly?

A
  • Bromocriptine
    -Amantadine
    -Selegiline
    -Anticholinergics
    -Levadopa
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15
Q

example of anticholinergics?

A

Trihexyphenidyl

Benzhexol

Benztropine

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16
Q

Medications linked to anxiety in elderly?

A

stimulants
B adrenergic inhalers (Albuterol, levalbuterol, and pirbuterol)

17
Q

what are B adrenergic inhalers

A

Al buterol
lev al buterol
pir buterol

18
Q

what do studies say change in drug absorption in elderly?

A

conflicting results.
clinically non-signficant reduction

19
Q

how change in drug distribution affect elderly?

A
  • Increase water soluble drug level
    -Decrease lipid soluble drug level
    -Increase half life of lipid soluble drugs
20
Q

what does contribute to change in drug distribution in elderly?

A

Reduction in water/lipid ration in body

Reduction in albumin

21
Q

how does reduction in albumin affect drug distribution?

A

there is more unbount fraction of lipid soluble drugs (active form) in blood

22
Q

what happens to drug hepatic metabolism in elderly?

23
Q

why drug hepatic metabolism reduced in elderly?

A

reduced blood flow
redcued enzyme activity

24
Q

what happens to drug excression in elderly

25
kidney function changes over time in elderly
by 65 ....35% is lost by 80 50% is lost
26
can we rely on serum creatinine and urea in elderly?
no- the muscle size is reduced and create less creatinine, so they're misleading
27
better ways to measure kidney function in elderly?
eGFR
28
what happens to drugs that are mainlyy excreted by kidney in elderly?
accumulate so lower dose is needed
29
example of drugs that are mainly excreted by kidney in elderly?
lithium sulpride
30
Why else you should generally start low in elderly?
increase receptor sensitivity start from half of adult dose
31
do elderly take longer or shorter to respond to drugs?
longer so be patient