Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Advanced Pharmacy Practice > Elderly Care > Flashcards

Elderly Care Flashcards

1
Q

What is the name of the score used for measurement of pain in people with dementia who cannot verbalise?

A

Abbey Pain Score

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Why is managing medicines in older people becoming more difficult? [3]

A
  1. More drugs, more treatments available - worried well.
  2. Interactions between disease states and medicines.
  3. Lack of appropriate trial data in the elderly patient.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What % of people over 75 take take 4 or more medicines?

A

60%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Why might people in care homes be on more medications?

A

Easier access to medication.

More likely to be vulnerable patients with other pathologeis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What medication is often over prescribed in care homes?

A

Sedatives - in the news recently.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What % of hospital admissions in the elderly are attributed to side effects of prescribed medications?

A

17%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is compliance?

A

The extent to which the patient’s behaviour matches the prescriber’s recommendations.

May not have capacity to agree (adherence).

Assumed non-ability to consent is wrong.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is adherence?

A

Adherence = the extent to which the patient’s behaviour matches agreed recommendations from the prescriber.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the newt guidelines?

A

Info on what drugs can be crushed, broken down, open etc to make consumption easier, within the license.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the reasons for unintentional non-adherence?

A 
Physical difficulty with packaging or devices.
Poor ability to swallow.
Confusion/memory problems
Poor communication/lack of information
Polypharmacy/complicated regimen.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the most common adjustment elderly people make deliberately?

A

Not taking water tablets if going out then taking double dose: leading AKI, dehydration.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How can we improve adherence?

A
  1. Large print labels and leaflets.
  2. Plain tops on bottles.
  3. Medication reminder cards: very useful.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Does Helena like multi-compartment compliance aids (MCAs)?

A

No.

Don’t like dosette boxes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What does a compliance aid assessment comprise of?

A
  1. Knowledge
  2. Visual issues
  3. Manual dexterity
  4. Cognition
  5. Supply.

MCAs are not appropriate for all patients - patients must be aware of the day and time of the day, have good manual dexterity and want his or her medications.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Can dabigatran be used in a dosette box?

A

No, needs to be taken into consideration when prescribing DOAC to elderly patients.

Rivaroxaban can be used.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

ADME

A

Absorption
Distribution
Metabolism
Elimination

17
Q

What is the most important aspect of ADME with regard to care of the elderly?

A

Elimination - renal function - decreases with age.

Can cause the accumulation of renally eliminated drugs.

18
Q

What two ways can we measure renal function?

A

eGFR
Creatinine clearance - best for use in elderly.

eGFR relies on body mass area.
In practice we use both and think about why the results may be different.

19
Q

Need to do work on other ADME changes.

A

…

20
Q

The effects of CNS-acting drugs is _________ in elderly.

A

Increased

21
Q

The effects of beta blockers are __________ in elderly.

A

Decreased

22
Q

What are some of the reasons for inappropriate prescribing?

A
  1. Over enthuisatic
  2. Failure to recognise adverse effects - prescribing a new drug to treat the side effects of a previous drug.
  3. Pt/relatives demand or refuse drug.
  4. Failure to individualise treatment to each patient.
  5. Inadequate review frequencies.
  6. Under prescribing because ‘old’ e.g. anticoagulants, antidepressents.
23
Q

What two drug classes are underprescribed in elderly?

A

Anticoagulants

Antidepressants

24
Q

What does start low and go slow mean?

A

Don’t cut a patients ramipril from 10mg od to 2.5mg od just because BNF says so.

25
Q

What is the STOPP/START tool?

A

STOPP = Screening Tool of Older Person’s Prescriptions

START: Screening Tool to Alert doctors to Right Treatment

26
Q

Digoxin doses of >___mcg are linked with impaired renal function.

A

125,

27
Q

Do ACEI need to be stopped in patient has poor renal function?

A

Not always - maybe withhold in AKI but normally keep them on.

Think about why they are on the ACEI = heart failure, diabetic (nephroprotection).

28
Q

Target BP in elderly is…… why?

A

150/100mmHg

Don’t want them to fall over.

29
Q

Dementia..

A

Progressive and largely irreversible syndrome that is characterised by a widespread impairment of mental function.

30
Q

National Dementia Strategy of

A

2009

31
Q

What should be the single point of referral for all people with a possible or suspected diagnosis of dementia?

A

Memory Assessment Services

32
Q

How can a dementia diagnosis be made?

A

Comprehensive assessment:

  1. Patient and carer history
  2. Examination
  3. Cognitive testing
  4. Review of medications that affect cognition.
  5. Rule out other causes e.g. delirium, depression.
  6. Blood tests to rule out reversible causes.
33
Q

The most common non-reversible types of dementia are:

A 
Alzheimers disease (62%)
Vascular dementia (17%) rapid onset. 
Mixed Vasc/A.D. (10%).
34
Q

Reversible types of dementia (1% of cases):

A 
Depression
Delirium
Drugs (see next slide)
Subdural haemorrhage
Brain tumour

Normal pressure hydrocephalus - dementia, recurrent falls, incontenence. TREATABLE, too much CSF in brain -> treated with tube which drains into peritoneal space.

Neurosyphilis
Vit B12 & folate deficiency
Hypothyroidism
Hypoglycaemia
Low sodium
High calcium
35
Q

What drugs can contribute to cognitive impairment?

A 
Anti-cholinergics - Oxybutynin
Anti-psychotics - Chlorpromazine
Anti-histamines
Anxiolytics - Benzodiazepines
Antidepressants – TCA’s,SSRI’s
Anticonvulsants - Phenytoin
Opiates
PD drugs
Lithium
Steroids
36
Q

Why do anti-cholinergics cause the side effects they do?

A

Acetylcholine is the main transmitter in parasympathetic nervous system. Inhibiting this causes urine retention. dry mouth, constipation, blurred vision.

37
Q

Why might anti-cholinergic agents have increased dementia-like effects in patients with existing dementia?

A

The BBB may be disrupted in dementia leading to increased susceptibility to these effects.

Advanced Pharmacy Practice (29 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions