Geriatrics- Drugs & Polypharmacy

Question 1

What are some common side effects of anticholinergics?

Answer 1

Confusion
Dry mouth
Constipation
Blurred vision
Urinary retention
Orthostatic hypotension

Question 2

What are some common side effects of tricyclics?

Answer 2

Confusion
Unsteady gait

Question 3

What are some of the common medication related problems which commonly affect geriatric patients?

Answer 3

Falls
Cognitive Loss /delirium
Dehydration
Incontinence
Depression

->can be subtle and easily mistaken for ‘growing old’.

Question 4

What is meant by prescribing cascade?

Answer 4

Prescribing one drug which causes an adverse drug reaction so another drug is given to try and help the problem and so on….

Question 5

Usually absorption of a drug is unaffected by old age. However, rate of absorption can decrease. Why?

Answer 5

One example would be GTN spray, which requires saliva to be absorbed.
Elderly patients may have dry mouth so might not be absrobed.

->particularly important for GTN spray as told to take another spray in 5mins if they don’t notice any improvement. Then wait and call an ambulance if not improving but may just ne that there has not been any time to absorb the medication.

Question 6

What changes distribution in drugs in older age?

Answer 6

Changes in body composition- reduced muscle mass, increased fat

Protein binding changes- decreased albumin

Question 7

How is metabolism of a drug affected by old age?

Answer 7

Most drugs metabolised by liver, decreased liver mass in older age so reduced first pass metabolism

Question 8

How is excretion of a drug affected by old age?

Answer 8

Renal function decreases with age.
Reduces clearance and increases half-life of many drugs which cna lead to toxicity.

Question 9

RECAP- pharmacodynamics?

Answer 9

Effect of drug on the body

Question 10

RECAP- pharmacokinetics?

Answer 10

Effect of body on the drug

Question 11

Why are psychiatric drugs, like sedatives, problematic in the elderly?

Answer 11

Can cause falls, confusion, postural hypotension, movement disorders

Question 12

Why are analgesia drugs, like NSAIDs, problematic in the elderly?

Answer 12

Can cause GI bleeding and renal impairment

Question 13

Why are cardiovascular drugs, like antihypertensives, problematic in the elderly?

Answer 13

May have exaggerated effects on BP, HR
More likely to develop postural hypotension

Question 14

Give some examples of the increased adverse effects in the elderly because of antibiotics.

Answer 14

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