Brainscape's Knowledge GenomeTM

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


See full index

3rd Year Medical Specialties > Elderly - Drugs and Polypharmacy > Flashcards

Elderly - Drugs and Polypharmacy Flashcards

You may prefer our related Brainscape-certified flashcards:
USMLE® Step 1 flashcards
1
Q

How common are ADRs in nursing home patients?

A

350,000 p/a

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

What are the common iatrogenic problems associated with Anticholinergics?

A 
Confusion
Constipation
Dry mouth
Blurred vision
Urinary retention
Orthostatic hypotension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the common iatrogenic problems associated with Tricyclics?

A

Confusion

Unsteady gait

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

What are the common iatrogenic problems associated with long-acting benzodiazapines?

A

CNS toxicity

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

What are the most common ADRs seen in older patients?

A 
Falls
Delirium
Dehydration
Depression
Incontinence
Loss of capacity/QoL
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the prescribing cascade?

A

Drug 1 has an adverse drug reaction, which is interpreted as a new condition for which
Drug 2 is give (+ new ADR)
Etc

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

What healthcare provider factors contribute to polypharmacy?

A 
No med review
Presuming patient expects drugs
Insufficient investigation 
Assumes drug is best 
No effort to simplify medication regimen
Lack of pharmacology knowledge
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the 5 worst drugs in polypharmacy associated with ADR admission?

A 
NSAIDS
Diuretics
Warfarin
ACEI
Antidepressants 
(Beta blockers, Opiates, Digoxin, Prednisolone, Clopridogrel)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the changes seen in absorption in old age?

A

Slowed rate of absorption, extent the same (delayed onset)

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

What are the changes seen in distribution in old age?

A

Changes in body composition
Changes in protein binding
Increased BB barrier permeability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How does protein binding change in old age?

A

Decreased serum albumin

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

How does body composition change in old age?

A

Reduced muscle mass
Increased fat mass
Reduced body water

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How does Increased fat mass affect drug distribution?

A

Increased action duration of fat soluble drugs

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

How does reduced body water affect drug distribution?

A

Increased levels of water soluble drugs

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

How does metabolism of drugs change in old age?

A

Hepatic metabolism changes due to decreased liver mass/blood flow
Reduced first pass metabolism

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

How does excretion of drugs change in old age?

A

Renal function decreases

Increases half-life of many drugs

17
Q

How do pharmacodynamics change in old age?

A

Increased sensitivity to drugs
Change in receptor binding
Lower receptor number

18
Q

How does the effect of diazepam change in old age?

A

Increased sedative effect

19
Q

How does the effect of warfarin change in old age?

A

Increased anticoagulation

20
Q

What are the principles of prescribing for older people?

A 
Be clear about diagnosis
Consider whether drug therapy is best 
Lower doses/reduced frequency
Consider ADR instead of new diagnosis
Check if lower dose is recommended
Review any prescriptions regularly 
Keep regimens simple
21
Q

What are the guides for prescription?

A

Beers’ Criteria
START-STOPP criteria
NHS Scotland Polypharmacy Guidance

22
Q

What is the role of the START-STOPP criteria?

A

Reduction in ADRs and LoS

23
Q

What is the indications for deprescription?

A 
Adverse drug reactions/interactions
Better alternative
Inaffective
Not indicated
Not evidence-based 
Minimise polypharmacy
24
Q

What are the drugs that are most often deprescribed in the elderly (>65)?

A

Antihypertensives
Benzodiazapines
Antipsychotics
Statins?

25
Q

What are the risks in psychiatric pharmacy of the elderly?

A

Care treating “agitation”
Sedatives increase falls/confusion
Antipsychotics have increased ADRs
Antidepressants less effective

26
Q

What are the risks in analgesic pharmacy of the elderly?

A

Opioids (more sensitive, tramadol less useful)

NSAIDs have increased adverse effects

27
Q

What are the “risky drugs” in cardiovascular pharmacy of the elderly?

A

Digoxin
Diuretics
Antihypertensives
Anticoagulants

28
Q

What risks are associated with digoxin use in the elderly?

A

Increased toxicity (use lower dose)

29
Q

What risks are associated with diuretic use in the elderly?

A

Decreased peak effect
Reduced clearance
Continence issues
Abnormal U+Es

30
Q

What risks are associated with antihypertensives use in the elderly?

A

Exaggerated effects on BP + HR
Increased postural hypotension
ACEI may not be well metabolised
Renal ADRs

31
Q

What risks are associated with anticoagulants use in the elderly?

A

Increased Warfarin sensitivity (so greater risk of ADRs)

32
Q

What risks are associated with antibiotics use in the elderly?

A

Increased ADRs

33
Q

What ADRs are seen with antibiotic use in the elderly?

A 
Diarrhoea + c. diff
Blood dyscrasias 
Delirium
Seizures
Renal impairment

3rd Year Medical Specialties (18 decks)

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