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Medical Specialties > Elderly - polypharmacy > Flashcards

Elderly - polypharmacy Flashcards

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USMLE® Step 1 flashcards
1
Q

What are common iatrogenic problems associated with anticholinergics?

A 
Confusion
Dry mouth
Constipation
Blurred vision
Urinary retention
Orthostatic hypotension
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2
Q

What are common iatrogenic problems associated with tricyclics?

A

Confusion

Unsteady gait

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3
Q

What are common iatrogenic problems associated with long acting benzodiazepines?

A

CNS toxicity

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4
Q

What are common iatrogenic problems associated with narcotics?

A

Confusion

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5
Q

What are common general adverse drug reactions in older patients?

A 
Falls
Cognitive loss/delirium
Dehydration
Incontinence
Depression
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6
Q

What are reasons older people get more prescriptions?

A

More acute and chronic diseases
More doctors visits
Drugs are often given to counteract side effects of another drug

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7
Q

What healthcare provider factors contribute to polypharmacy?

A

No med review with patient on regular basis
Presumes patient expects meds
Prescribes without sufficient clinical investigation
Evidence that drug is ‘best’ drug for problem
Providing unclear instructions about how to take meds
Ordering automatic refills
Lack of geriatric pharmacology knowledge

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8
Q

What are the 3 worst drugs for admissions related to adverse drug reactions in the elderly?

A

NSAIDS
Diuretics
Warfarin

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9
Q

What happens to drug absorption in older people?

A

Decreased rate but overall the same

May see a delayed onset of action of drug

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10
Q

How does drug distribution change within elderly patients?

A

Body composition changes - increased fat, decreased muscle - Increased distribution of fat soluble drugs
Protein binding decreases due to decreased albumin
Increased blood brain barrier permeability

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11
Q

How does drug metabolism change in the elderly?

A

First pass metabolism decreases due to decreased liver mass and decreased hepatic blood flow

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12
Q

How does excretion change in the elderly?

A

Renal function decreases with age leading to decreased excretion

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13
Q

What happens as a result of decreased excretion?

A

Increased drug half-life leading to toxicity

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14
Q

What happens regarding pharmacodynamics in elderly people?

A

Increased sensitivity of some medicines

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15
Q

What causes increased drug sensitivity in older patients?

A

Change in receptor binding
Decrease in receptor number
Altered translation of receptor cell response

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16
Q

What are principles of prescribing for older people?

A

Clear diagnosis to avoid prescribing drug to manage adverse effect
Consider whether drug therapy is best therapeutic action
Lower doses or reduced frequency of administration are generally needed
Think of whether drug causes problems in elderly patients
Check whether lower dose is recommended in elderly
Review new drug and see if it’s achieving its aim
Review all prescriptions regularly
Try to keep regimens simple
Consider compliance issues elderly patient may experience

17
Q

What are tools for prescribing in older people?

A

Beers’ criteria
START-STOPP criteria
NHS Scotland Polypharmacy Guidance

18
Q

What is Beers’ criteria used for?

A

List of inappropriate drugs for older people

Occassionally updated but many weakness

19
Q

What is START-STOPP criteria used for?

A

Advice on medical optimisation

Mostly used as a research tool

20
Q

What are the 7 steps of the NHS Scotland Polypharmacy Guidance?

A

Identify objectives of therapy
Identify essential drug therapy
Does the patient take unecessary drug therapy
Are therapeutic objectives being achieved
Does the patient have ARDs or at risk of ARDs
Is drug therapy cost effective
Is patient willing and able to take drug therapy as intended

21
Q

When would you deprescribe a drug?

A 
ADR
Drug-drug interaction
Better alternative drug
Not effective
Not indicated
Not evidence-based
Minimise polypharmacy
22
Q

What are risks of psychiatric medication in older people?

A

Sedatives - falls, confusion
Anti-psychotics - Postural hypotension, stroke, confusion, movement disorders
Anti-depressants - less effectove

23
Q

What are risks of opioids in older people?

A

More sensitive to the effects so may need lower doses

24
Q

What are risks of NSAIDs in older people?

A

Increased adverse effects - renal impairment, GI bleeding

25
Q

What is the main risk of digoxin in older people?

A

Increased toxicity - lower dose needed

26
Q

What are risk factors of anti-hypertensives in elderly patients?

A

May have exaggerated effects on BP and heart rate
More likely to see issues with postural hypotension
ACE inhibitors pro drugs which may not be metabolised to active form
Renal adverse effects

27
Q

What are risks of warfarin in elderly patients?

A

More sensitive to effects

Greater risk - GI bleeding, falls

28
Q

What are adverse effects of antibiotics in older people?

A 
Diarrhoea and c. diff infection
Blood abnormalities
Delirium
Seizures
Renal impairment

Medical Specialties (23 decks)

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