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C. Year 3: Clinical Pharmacology, Therapeutics and SBOM > Elderly Medicine Prescribing > Flashcards

Elderly Medicine Prescribing Flashcards

1
Q

Polypharmacy is when patients are taking a lot of drugs at the same time. But how many drugs is defined as polypharmacy?

1 - >3
2 - >4
3 - >5
4 - >7

A

3 - >5

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2
Q

What % of >65s take >10 medications?

1 - 1.6%
2 - 16%
3 - 36%
4 - >66%

A

2 - 16%
- elderly patients in hospital are typically on >6 medications
- BUT they gain an additional 3 upon discharge

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3
Q

Are adverse reactions to medications more common in those taking more or less medications?

A
  • more medications
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4
Q

What % of hospital admissions are due to adverse drug reactions?

1 - 6.5%
2 - 25%
3 - 45%
4 - >70%

A

1 - 6.5%

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5
Q

Pharmacokinetics relates to what effect the body has on medications. In elderly patients they may need to be given medications in a different way as they have dysphagia, such as stroke or Parkinsons disease. Which of the following is NOT an option if a patient has dysphagia?

1 - oral fluid intake
2 - patches
3 - rectal
4 - oral tablets

A

4 - oral tablets

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6
Q

In a patient with hyperactive delirium or dementia, which of the following methods would be the last choice if the patient is restless?

1 - continuous IV
2 - SC/IM injection
3 - bolus medication/fluids
4 - topical patches

A

1 - continuous IV
- patients may pull out their IV lines
- compliance can also be a major issue

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7
Q

Pharmacokinetics relates to what effect the body has on medications. Which of the following is NOT a common occurrence in elderly patients that can affect how drugs are absorbed?

1 - gastric secretions
2 - reduces GIT splanchnic blood flow
3 - cholecystectomy
4 - GIT disease (coeliac, IBD)
5 - co-prescription drugs affected absorption

A

3 - cholecystectomy

  • e.g., omeprazole reduces gastric acid secretions and therefore may affect drugs that need a low pH
  • antacids can bind other drugs, for example Levothyroxine binds to iron and reduces its absorption
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8
Q

Pharmacokinetics relates to what effect the body has on medications. In an elderly patient distribution will be changed. If a patient takes a water soluble drug and has a decrease in lean mass and an increase in fat mass, will the serum levels of the drug be higher or lower?

A
  • higher
  • drugs cannot be absorbed by fat so remain in the blood
  • examples are gentomyocin and digoxin, where doses need to be altered
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9
Q

Pharmacokinetics relates to what effect the body has on medications. In an elderly patient distribution will be changed. If a patient has chronic inflammation and/or malnutrition then their albumin can be low. Will the bioactive level of the drug increase or decrease?

A
  • will increase
  • albumin typically binds drugs and acts as a reservoir
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10
Q

Pharmacokinetics relates to what effect the body has on medications. In an elderly patient distribution will be changed. If a patient has reduced liver mass and blood flow, what affect does that have on 1st pass metabolism?

A
  • reduces 1st pass metabolism
  • can result in accumulation of drugs in liver becoming toxic, such as morphine
  • lower doses of morphines are use in elderly
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11
Q

Pharmacokinetics relates to what effect the body has on medications. In an elderly patient distribution will be changed. The mnemonic SICKFACES.COM can be used to remember the enzyme inhibitors:

A
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12
Q

Pharmacokinetics relates to what effect the body has on medications. In an elderly patient distribution will be changed. The mnemonic SCRAP GP can be used to remember the enzyme inhibitors:

A
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13
Q

Is acute alcohol use a liver enzyme inducer or inhibitor?

A
  • inhibitor
  • BUT chronic alcohol use is an alcohol inducer
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14
Q

Pharmacokinetics relates to what effect the body has on medications. In an elderly patient distribution will be changed. Which organ is most commonly affected in elderly and affected the elimination of drugs?

1 - heart
2 - spleen
3 - liver
4 - kidneys

A

4 - kidneys
- multifactorial reduction in eGFR

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15
Q

Which medication is avoided the most in the elderly due to its affects on the liver and other organs?

1 - gentamicin’s
2 - NSAIDs
3 - lithium
4 - digoxin

A

2 - NSAIDs

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16
Q

Pharmacodynamics relates to what effect the medications have on the body. Do BP pressure medications typically have a greater or lesser effect on BP in elderly patients?

A
  • greater effect
  • can reduce BP more than in younger patients and causes postural hypotension
17
Q

Pharmacodynamics relates to what effect the medications have on the body. Do cardiovascular drugs have a greater or lesser chronotropic (relates to HR) effect?

A
  • lesser response
  • doesn’t reduce the HR as well as in younger patients
  • typically need higher doses of medications
18
Q

Pharmacodynamics relates to what effect the medications have on the body. Which of the following can occur in elderly patients taking psychotropic medications?

1 - Increased Extra Pyramidal Side Effects
2 - Increased delirium
3 - Increased sedation at lower dose
4 - all of the above

A

4 - all of the above

  • antipsychotics = Increased Extra Pyramidal Side Effects -
  • anticholinergics = Increased delirium
  • diazepam = Increased sedation at lower dose (avoid where possible)
19
Q

Pharmacodynamics relates to what effect the medications have on the body. In an elderly patient would we expect to see an increased or decreased inhibition of vitamin K in patients using Warfarin?

A
  • increase vitamin K inhibition
  • can increase the risk of bleeding
  • lower doses are used
20
Q

When trying to diagnose a patient with polypharmacy, should the adverse events of drugs they may be taking be included in their potential differentials?

A
  • always
  • polypharmacy combined with ageing increases the risk of adverse events
21
Q

When prescribing for an elderly patient, should their disease or quality of life be the priority?

A
  • health is always important, but not if the patients quality of life is impaired
22
Q

In elderly patients should the dosage of drugs be the same in a younger patient with the same condition?

A
  • no
  • we should start on lower dosages and slowly titrate them as required
23
Q

When prescribing drugs, we need to be very careful to make sure that we don’t prescribe and antagonist to the drug we are providing. For example, if we prescribe Donepezil for dementia, which of the following would be the antagonist of this drug and negate the effects of Donepezil?

1 - Solifenacin
2 - Lisinopril
3 - Warfarin
4 - Haloperidol

A

1 - Solifenacin

  • Donepezil = Acetylcholinesterase increase ACh levels
  • Solifenacin = Anticholinergics reduces effectiveness of ACh
24
Q

When prescribing in elderly patients, should we prescribe patients 1 drug at a time or does it matter prescribing them together?

A
  • 1 drug at a time
  • prescribing 2 or more drugs simultaneously means if there is an adverse reaction, we don’t know whats caused it
25
Q

All of the following should have a drugs review for medications they may no longer need. Which one is NOT a patient who should have a drugs review?

1 - patient admitted with adverse drug reaction
2 - patient on >10 regular medications
3 - patient >80 y/o
4 - patient with history of fall:
5 - patient with high frailty scores
6 - patients receiving palliative care

A

3 - patient >80 y/o
- may be fit and well, so no need for a medication review

26
Q

Which of the following is most commonly used to screen and identify which drugs elderly patients should not be taking and which drugs they should be taking?

1 - STOPP / START criteria
2 - Beer’s Criteria
3 - Deprescribing.org
4 - Anticholinergic risk scale

A

1 - STOPP / START criteria
- all of the methods can be used, but this is the most common and is recommended by the BNF
- Green = continue taking
- Red = stop taking

27
Q

Up to 50% of medication is not taken by elderly patients. Which of the following is NOT a patient factor that can contribute to this?

1 - sensory impairments
2 - side effects
3 - cognitive impairments
4 - lack of caregiver

A

2 - side effects
- this is a medication factor that can also contribute to medications not being taken

28
Q

Up to 50% of medication is not taken by elderly patients. Which of the following is NOT a medication factor that can contribute to this?

1 - sensory impairments
2 - side effects
3 - polypharmacy
4 - poor labelling

A

1 - sensory impairments
- this is a patient factor

29
Q

Up to 50% of medication is not taken by elderly patients. Which of the following is NOT a healthcare factor that can contribute to this?

1 - lack of patient education
2 - side effects
3 - regular follow-ups
4 - patient involvement

A

2 - side effects
- this is a medication factor

30
Q

A 79yo man is admitted with a tonic clonic seizure for the 3rd time in 1 month. During his in-patient stays he has had no seizures. He has a PMHx of stroke and rheumatoid arthritis. He recently lost his wife and lives alone. DHx: Levetiracetam (anti-epileptic), Clopidogrel, Omeprazole, Atorvastatin.
What is the most likely cause for his recurrent seizures:

A) Levetiracetam overdosage
B) Alcohol misuse and liver enzyme induction
C) Omeprazole induced liver enzyme inhibition
D) Poor compliance with Levetiracetam
E) Previous stroke progressing to vascular dementia

A

D) Poor compliance with Levetiracetam
- no seizures in hospital as drug will definitely be prescribed
- previous stroke, RA and loss of wife could all have contributed to poor compliance

C. Year 3: Clinical Pharmacology, Therapeutics and SBOM (25 decks)

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