Elderly - 2 Flashcards
Most common reversible cause of delirium & dementia in elderly?
Medications
Drug class that have most association with dementia in elderly?
Opioids
Benzodiazepines
Anticholinergics
which one is more troublesome in elderly?
Short acting or long acting benzo?
Long acting
which neuroleptic have found in orthopedic RCT to have higherst RR for delirium in elderlyy ?
Haloperidol
How many folds opioids increase risk of delirium in elderly?
2 folds
which opioids has higherst risk of delirium in elderly?
Pethidine
why pethidine has higherst risk for delirium in elderly?
It accumulate.
Renal function declines
Its metabolite has anticholinergic
Antipsychotics with anticholinergic properties
Clozpaine, Chlorpromazine and Thioridazine = +++++
Olanzapine= +++
Loxapine and Quetiapine = ++
True or false
Newer antipsychotic have less anticholinergic effects
True
Mnemonic for Drugs that cause Mood change in elderly?
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
anti hypertesives that cause depression in elderly?
reserpine
methyldopa
clonidine
What does interferon -a is capable of in elderly?
induing depression
Medications linked to psychosis in elderly?
Anti parkinsons
Corticosteroids
which anti parkinson’s cause psychosis in elderly?
- Bromocriptine
-Amantadine
-Selegiline
-Anticholinergics
-Levadopa
example of anticholinergics?
Trihexyphenidyl
Benzhexol
Benztropine
Medications linked to anxiety in elderly?
stimulants
B adrenergic inhalers (Albuterol, levalbuterol, and pirbuterol)
what are B adrenergic inhalers
Al buterol
lev al buterol
pir buterol
what do studies say change in drug absorption in elderly?
conflicting results.
clinically non-signficant reduction
how change in drug distribution affect elderly?
- Increase water soluble drug level
-Decrease lipid soluble drug level
-Increase half life of lipid soluble drugs
what does contribute to change in drug distribution in elderly?
Reduction in water/lipid ration in body
Reduction in albumin
how does reduction in albumin affect drug distribution?
there is more unbount fraction of lipid soluble drugs (active form) in blood
what happens to drug hepatic metabolism in elderly?
reduced
why drug hepatic metabolism reduced in elderly?
reduced blood flow
redcued enzyme activity
what happens to drug excression in elderly
reduced
kidney function changes over time in elderly
by 65 ….35% is lost
by 80 50% is lost
can we rely on serum creatinine and urea in elderly?
no- the muscle size is reduced and create less creatinine, so they’re misleading
better ways to measure kidney function in elderly?
eGFR
what happens to drugs that are mainlyy excreted by kidney in elderly?
accumulate
so lower dose is needed
example of drugs that are mainly excreted by kidney in elderly?
lithium
sulpride
Why else you should generally start low in elderly?
increase receptor sensitivity
start from half of adult dose
do elderly take longer or shorter to respond to drugs?
longer
so be patient
