Iatrogenic

Question 1

epidemiology

Answer 1

90% of older people have prescriptions
>50% of 65-74yo take 3+ (>70% >75y); 12.6% of interactions involve polypharma
30% of ADRs occur in elderly; 6-17% of elderly IP have ADR
10-12% of acute Ax due to prescriptions; 1in4 older adults over 5y; 6.5% of all Ax are ADRs; 30-55% avoidable
30% >65y, 50% > 80y have a fall each year: hyptnotics, ADD, APD, thiazides, NSAIDs
increased fracture risk: SSRIs, glitazones, CST, PPO

Question 2

Definition of bad prescribing

Answer 2

contraindicated drugs
wrong dose/duration
adverse effect on prognosis
missing indicated/effective drugs

Question 3

pharmacokinetics in HCE

Answer 3

distribution: fat, water, binding
metabolism: hepatic blood and enzymes
excretion: decreased kidney function/clearance

Question 4

pharmacodynamics in HCE

Answer 4

increased sensitivity: BZD, antiHTN, TCA, warfarin

decreased sensitivity: BA, BB

Question 5

prescribing principles in HCE

Answer 5

Barber: effective, safe, cost, patient factors (ease, comorbid, allergy, compliance)

Question 6

medicines management (r/v)

Answer 6

stopp/start criteria: review systems

Question 7

high risk situations

Answer 7

transfer, DH extensive, ABx (C-diff: coamox, clinda, cipro, defuroxime)

Question 8

high risk meds

Answer 8

NSAIDs: 29% of ADR Ax; GI, CVS, HTN, resp, AKI
diuretics: Na, HTN, AKI, falls, dehydration
warfarin: falls, cognition
anti-HTN: falls, K
ADD/APD: Na, seizure, cog, bleed, Loc, SS
hypnotics: falls
digoxin: arryhtmia, N&V
opitiates: sedation, constipation
vanc/gent: oto/nephrotoxic

Question 9

RF and consequences

Answer 9

more chronic diseases, polypharmacy, physiology (renal/liver/muscle), multiple Dr

longer Ax duration, M&M, ADRs/interactions, compliance

Question 10

application

Answer 10

ID and treat medical issues
r/v polypharmacy + consult: # and doses
monitor
MDT + CGA
best evidence + lowest risk/SE

Question 11

ADR risks

Answer 11

cognition (12x), 
4+ comorbidities (8x)
dependent (4x), non-adherence (2x)
impaired renal function (2.5x)
polypharma (2.7x)

poor mental health poor home support, poor dexterity/senses

altered physiology, pharmacodynamics, pharmacokinetics