Elderly- Polypharmacy

Question 1

What are examples of ADR presentations that could be confused with normal ageing?

Answer 1

• Unsteady
• Dizzy
• Confusion
• Falls
• Depression
• Incontinence

Question 2

What is the process of the prescribing cascade?

Answer 2

• Given a drug that causes an ADR
• ADR interpreted as a new condition
• Given another drug to treat the ADR

Question 3

What are the 2 most dangerous drugs for polypharmacy?

Answer 3

Sedatives

Anticholinergics

Question 4

How is absorption of a drug affected by age?

Answer 4

The rate of absorption decreases but the extent of absorption doesn’t

Question 5

How is the distribution of a drug affected as age increases?

Answer 5

Decreased albumin
Increased adipose fat
Decreased water content

Question 6

How does the decrease in albumin affect the distribution of a drug?

Answer 6

Less protein binding

Greater serum conc of acidic drugs e.g. furosemide

Question 7

How does the increase in adipose tissue affect the distribution of a drug?

Answer 7

Fat soluble drugs

Increased volume of distribution, rate of absorption and half life

Question 8

How does the decrease in water content affect the distribution of a drug?

Answer 8

Water soluble drugs

Decreased volume of distribution, rate of absorption and half life

Question 9

How is the metabolism of a drug affected as age increases?

Answer 9

There is decreased hepatic metabolism

Question 10

What does a decrease in hepatic metabolism result in a decrease of?

Answer 10

• Decreased liver mass and blood flow to the liver

* Decreased first pass metabolism

Question 11

What does a decrease in hepatic metabolism result in an increase of?

Answer 11

• Increased toxicity of drugs metabolised in the liver

* Increased availability of Pro-drugs

Question 12

How is the excretion of a drug affected as age increases?

Answer 12

Renal function decreases
• Reduced clearance- increased half life
• Toxicity

Question 13

What pharmacodynamic changes are there with increasing age?

Answer 13

• Changes in receptor binding, number, and effect
• Increased sedation on diazepam
• Increased anti-coagulation on warfarin

Question 14

What are the side-effects of benzodiazepines in the elderly?

Answer 14

Falls

Confusion

Question 15

What are the side-effects of anti-psychotics in the elderly?

Answer 15

Postural hypotension
Stroke
Confusion
Movement disorders

Question 16

What is the problem with anti-depressants in the elderly?

Answer 16

They are more dangerous and less effective

Question 17

How does the dose of digoxin and opioids need to be changed?

Answer 17

Decrease the dose- there is increased toxicity

Question 18

What are the possible side effects of NSAID’s in the elderly?

Answer 18

Renal impairment

GI bleeding

Question 19

What are the possible side-effects of antibiotics in the elderly?

Answer 19

• Increased adverse effects
• Diarrhoea and c. diff infection
• Blood dyscrasias (trimethoprim, co-trimoxazole)
• Delirium (quinolones)
• Seizures
• Renal impairment (aminoglycosides)

Question 20

What are the possible side-effects of warfarin in the elderly?

Answer 20

• More sensitive to warfarin

- Greater risk from warfarin i.e. GI bleeding, falls