I - Appropriate prescribing and polympharmacy Flashcards
What is the difference between screening and diagnostic?
Screening tests are done on a wide range of otherwise healthy individuals to look for potential diseases Diagnostic tests are carried out on a single individual to test find out if they have the suspected disease
At what age do all men receive the AAA screening?
All men receive this at 65 years of age
The screening involves coming in for an ultrasound scan to detect for the presence of an abominal aortic aneurysm If there is an aneursym presen, treatment depends on the size WHat is done if: Aneurysm - 3to4.4cm? 4.5 to 5.4cm? >5.4 cm?
3 to 4.4 cm - one yearly scans are carried out to see progression of the aneursym 4.5 to 5.4 cm - 3 monthly scans are carried out as aneurysms this size are more dangerous >5.4 cm means referral for operation
What are the vaccines that the elderly recieve? Ie what do they recieve from the age of 65
At the age of 65 a yearly Influenza vaccine =/> 65 years old - Pneumoccocal vaccine 70 years of age - a one off shingles vaccine is administered
What is the recommended physical activity levels for a person aged above 65?
150 minutes of moderate intensity exercise over the week or 75 minutes of vigorous exercise per week And Strength exercises on >/= 2 days per week
1) Aspirin in someone with iron deficiency anaemia 2) Zopiclone in someone at high risk of falls 3) Quinine in someone with cramps 4) Omeprazole in someone with indigestion but no ulcers 5) Simvastatin in someone with metastatic breast cancer In each of these cases why should the drug be discontinued?
Aspirin could be causing a GI bleed and worsening the anaemia therefore stop it Zopiclone is used to treat insomnia and worsens the risk of falls so stop this also if no insominia Quinine doesnt work and has many side effects Omeprazole is used to treat stomach ulcers and indigestion - they can cause Cdiff and can worsen osteoporsosis increasing likelihood of falsl Statins are only for cholesterol, not cancer
Bad prescribing examples involve giving drugs to treat the side effects of other drugs which could in itself increase more likelihoods of eg falls Give an example of when this is carried out?
When giving amlodopine to treat the ankle swelling caused by furosemide
What are drug examples that increase risk of falls?
Benzodiazepines Neuroleptic Opiates Anti-psychotics Anti-hyertensives
Mr B has angina, hypertension and heart failure You could treat him with nicorandil, bendroflumethiazide and digoxin Or you could give him a betablocker to treat all three… Which do you give and why?
Give the beta blocker - much easier taking one medication than three and has the effect that it actually treats all three conditions
what you are going to do with each of these medications… Stop aspirin? Continue aspirin? Change to clopidogrel? What about the omeprazole?
Stop the aspirin and omeprazole - gastric ulcer doesn’t take 23 years to heal and aspirin has no use anymore as femur fracture was 8 years ago
What should happen with regards to the zopiclone and citalopram? (geriatric depression score is high)
Stop zopiclone - patient doesn’t have insomnia CHange to a different SSRI as citalopram is evidently not working eg fluoxetine
What should happen to the betahsitine? (what is this used for) Amlodopine, furosemide and digoxin?
Take off betahistine - used to treat BPPV and he has no history of vertigo Take of amlodipine, furosemide and digoxin and start on a beta blocker instead - will help with heart rate, and HBP
What should the medication review of this gentleman look like now?
SSRI - fluoxetine for depression Beta blocker - for HBP, heart rate Paracetamol - pain control without the sedatory side effects Warfarin - protective against the Afib and has a history of stroke Consider amlodipine due to his high blood pressure
What is polypharmacy again and why is it bad? What age group is it most common in?
The taking of 4 or more medications and increases the risk of falls Most common in thse above the age of 65
