Elderly - 2

Question 1

Most common reversible cause of delirium & dementia in elderly?

Answer 1

Medications

Question 2

Drug class that have most association with dementia in elderly?

Answer 2

Opioids
Benzodiazepines
Anticholinergics

Question 3

which one is more troublesome in elderly?

Short acting or long acting benzo?

Answer 3

Long acting

Question 4

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

Answer 4

Haloperidol

Question 5

How many folds opioids increase risk of delirium in elderly?

Answer 5

2 folds

Question 6

which opioids has higherst risk of delirium in elderly?

Answer 6

Pethidine

Question 7

why pethidine has higherst risk for delirium in elderly?

Answer 7

It accumulate.
Renal function declines
Its metabolite has anticholinergic

Question 8

Antipsychotics with anticholinergic properties

Answer 8

Clozpaine, Chlorpromazine and Thioridazine = +++++

Olanzapine= +++

Loxapine and Quetiapine = ++

Question 9

True or false

Newer antipsychotic have less anticholinergic effects

Answer 9

True

Question 10

Mnemonic for Drugs that cause Mood change in elderly?

Answer 10

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

Question 11

anti hypertesives that cause depression in elderly?

Answer 11

reserpine
methyldopa
clonidine

Question 12

What does interferon -a is capable of in elderly?

Answer 12

induing depression

Question 13

Medications linked to psychosis in elderly?

Answer 13

Anti parkinsons
Corticosteroids

Question 14

which anti parkinson’s cause psychosis in elderly?

Answer 14

• Bromocriptine
  -Amantadine
  -Selegiline
  -Anticholinergics
  -Levadopa

Question 15

example of anticholinergics?

Answer 15

Trihexyphenidyl

Benzhexol

Benztropine

Question 16

Medications linked to anxiety in elderly?

Answer 16

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

Question 17

what are B adrenergic inhalers

Answer 17

Al buterol
lev al buterol
pir buterol

Question 18

what do studies say change in drug absorption in elderly?

Answer 18

conflicting results.
clinically non-signficant reduction

Question 19

how change in drug distribution affect elderly?

Answer 19

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

Question 20

what does contribute to change in drug distribution in elderly?

Answer 20

Reduction in water/lipid ration in body

Reduction in albumin

Question 21

how does reduction in albumin affect drug distribution?

Answer 21

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

Question 22

what happens to drug hepatic metabolism in elderly?

Answer 22

reduced

Question 23

why drug hepatic metabolism reduced in elderly?

Answer 23

reduced blood flow
redcued enzyme activity

Question 24

what happens to drug excression in elderly

Answer 24

reduced

Question 25

kidney function changes over time in elderly

Answer 25

by 65 ….35% is lost

by 80 50% is lost

Question 26

can we rely on serum creatinine and urea in elderly?

Answer 26

no- the muscle size is reduced and create less creatinine, so they’re misleading

Question 27

better ways to measure kidney function in elderly?

Answer 27

eGFR

Question 28

what happens to drugs that are mainlyy excreted by kidney in elderly?

Answer 28

accumulate

so lower dose is needed

Question 29

example of drugs that are mainly excreted by kidney in elderly?

Answer 29

lithium

sulpride

Question 30

Why else you should generally start low in elderly?

Answer 30

increase receptor sensitivity
start from half of adult dose

Question 31

do elderly take longer or shorter to respond to drugs?

Answer 31

longer
so be patient