Geriatrics II

Question 1

Common iatrogenic drug problems

Answer 1

ANTICHOLINERGICS
Confusion, dry mouth, constipation, blurred vision, urinary retention and orthostatic hypotension

TRICYCLICS
confusion, unsteady gait

BENZOS
LT CNS tox.

NARCOTIS
confusion

Question 2

Patterns in pharmacodynamics in elderly

Answer 2

• delayed onset of action via GI / oral route
• raised adipose = increased duration of action of fat sol drugs
• reduced body water = water sol drugs remain in serum longer
• decreased albumin = less binding and more serum
• decreased hepatic metabolism = tox.
• increased sedation w/ diazepam
• increased anticoag. w/ warfarin

=> LOWER DOSES GENERALLY NEEDED

Question 3

Tools for PRescribing in Elderly

Answer 3

Beers’ criteria
List of ‘inappropriate’ drugs for older people
Updated occasionally but many weaknesses

START-STOPP criteria (O’Mahony et al)
Advice on medical optimisation
A lot to remember, so mostly research tool

NHS Scotland Polypharmacy Guidance

Question 4

Deprescribing

Answer 4

Systematic review of medication withdrawal trials in people aged >65

• diuretics
• antiHT
• psychotopics
  !!ANTICHOLINERGICS & SEDATIVES = most adverse

ADR for polypharmacy
NSAIDs 29.6%
Diuretics 27.3%
Warfarin 10.5%
ACEI 7.7%
Antidepressants 7.1%
Beta blockers 6.8%
Opiates 6.0%
Digoxin 2.9%
Prednisolone 2.5%
Clopidogrel 2.4%

Question 5

Association withquinolones (abx)

Answer 5

DELIRIUM

Question 6

Head injuries and falls

Answer 6

think subdurals: common in elderly and alcoholics
* crescent shape
* may be followed by delirium

Question 7

Head injuries and falls

Answer 7

think subdurals: common in elderly and alcoholics
* crescent shape
* may be followed by delirium