Geriatrics Flashcards
Where are most drugs excreted in the body?
Explain the differences in drug excretion in older people & the effect this has on drug action:
Kidneys
Reduced kidney function = less excretion of the drug → drug has a longer action in the body
Where are most drugs metabolised in the body?
Explain the differences in drug metabolism in older people:
What effect does this have on serum conc. of drug?
How does this affect the onset & effect of pro-drugs? (drugs that are activated by the liver into their active form)
Liver metabolises most drugs!
Drug metabolism
→ liver works slower in older people SO metabolism of drugs is also slower
→ reduced 1st pass metabolsim
Effect on drugs action:
Reduced 1st pass metabolism = more drug in circulation that can have an affect (as it is being removed at a slower rate)
Pro-drugs
Less active form of the drug in circulation so ONSET = delayed, EFFECT = weaker (as there is less active drug)
What tool do GP’s use to determine whether a patient with a chronic condition is nearing their end of life & palliative care should take place?
What tool can be used to assess & review functional changes in palliative patients health?
~ a lower % indicates a better/ poor prognosis?
SPICT (supportive & palliative care indicators tool)
PPS (palliative performance scale)
~ lower % on the scale indicates poorer prognosis
Describe the meaning of frailty:
List the 5 decompensated frailty syndromes:
Increased susceptibility to environmental stress that the body isn’t able to physiologically deal with (eg catching a pneumonia/ falling)
1) Falls
2) Immobility
3) Delirium
4) Incontinence
5) Susceptibility to S/E of medications (eg, confusion with coediene, hypotensions with antidepressants)
If a UTI is suspected in older, hospitalised patients, what test should be done to confirm the UTI?
~ Explain why this is done
Urine sample should be sent for analysis - DO NOT DO URINE DIP
Most older people have asymptomatic bacteriurea which will indicate infection on a urine dip so need to send the sample for analysis!
List some common drugs that cause ADR’s in the elderly: (8)
_1) Anti-cholinergics
2) Sedatives (eg benzodiazepines)_
- Opioids
- Anti-psychotics
- NSAIDs
- Diuretics
- Anti-hypertensives
- Antibiotics
What type of dementia is most common in the under 65’s age group?
Alcohol related brain damage (ARBD)
The body compostion changes with age. In regards to the following, state what you would expect in older people, compared to young:
a) muscle mass
b) adipose tissue (fat)
c) % body water
d) albumin
e) permeability of the BBB
a) Reduced muscle mass
b) Increased adipose tissue
c) Reduced body water %
d) Reduced albumin
e) Increased permeability of BBB
List some common side effects of antimuscarinics in the elderly: (5)
- dry mouth
- constipation
- confusion/ delirium
- falls
- urinary retention
A patient with delirium does not have capacity. - T/F
Capacity is decision specific. - T/F
False, some patients may still have capacity
True, a patient may not have capacity for more complex decisions but may retain capacity for basic decisions
What is anticipatory care planning (ACP)?
What might be discussed in an anticipatory care plan?
Once a patient is ‘palliative’ & ACP has been discussed, what happens in regards to their records in the GP practice?
~ who is informed about this?
~ is the patient frequently reviewed? - who is involved in this?
This is a discussion with a palliative patient & their carers regarding their wishes for their future care.
- Do they want a DNACPR?
- Where do they want to die?
- Would they want treatment for a simple infection?
Once palliative & have had the ACP discussion, the patient is placed on a Palliative Care Register in the practice.
~ patients plan is sent to OOH & anyone who is invovled with their care
~ GP practice has regular palliative care meetings with an MDT to discuss all palliative patients
What is delirium?
What is a screening tool for delirium?
What is the management of delirium? (5)
An acute confusional state
4AT
Non-pharmacological management !!!!!
~ Stop/ treat any precipitating factors (eg medications, infection)
~ Mobilise patient asap
~ Make patient familiar with their surroundings
~ Normalise sleep-wake cycle
~ Discharge from hospital ASAP
List the 3 main features of delirium:
1) Fluctuating consciousness
~ hypoactive
~ hyperactive
~ disrupted REM sleep
2) Change in cognition
~ confusion
~ memory impairment
3) Acute onset
Explain the effects that the below changes in body composition in the elderly have on the drug effects:
a) increased adipose tissue
→ volume of distribution
→ duration of action/ half life
b) reduced body water
→ volume of distribution
→ serum concentration
→ duration of action
c) reduced albumin
→ serum concentration
→ effect of drug
a) Increased adipose tissue
→ increased volume of distribution of fat soluble drugs
→ fat soluble drugs will have longer 1/2 life & duration of action!
b) Reduced body water
→ lower volume of distribution of water soluble drugs
→ higher serum concentration
→ reduced duration of action
c) Reduced albumin
→ reduced amount of drug will be bound to albumin (as there is less of it)
→ higher serum concentration of active drug
→ bigger (stronger) effect of drug produced
What is a ‘just in case’ box?
What 4 medications would be included within it?
Just in case box: Given to patients at end of life. It includes medicines that can be quickly administered if the patient has any distress.
- Opioid for pain/breathlessness (morphine)
- Sedative for anxiety/agitation/breathlessness (midazolam)
- Anti-secretory for resp secretions (Hyoscine butylbromide injection)
- Anti-emetic for nausea and vomiting (levomepromazine injection)
