Lecture 23 - Disorders of ageing Flashcards
Describe the general principles of prescribing in elderly for absorption/ distribution.
Less body water so there is higher plasma concentration of water-soluble drugs for example, lithium and antibiotics.
Less lean body mass means less binding so there is higher plasma concentration of highly muscle bound drugs for example, digoxin.
Less plasma protein (albumin) means less binding so there is higher concentration of plasma protein-bound drugs for example, phenytoin and warfarin.
Metabolism is reduced due to smaller liver mass, so less liver blood flow and reduced enzyme function.
Describe excretion in prescribing of elderly people
there is shrinkage in kidney size, less blood flow which means reduced renal function.
normal creatinine concentrations are possible in older people with significant renal impairment. we use GFR to estimate renal function.
Dose adjustments are required for renal impairment for example, lithium and sulprimide
what are CNS disorders of ageing?
loss of neutrons and neurotransmitters (cognitive impairment/ dementia eg alzeihmers or Lewy body)
vascular changes to the brain affecting blood/oxygen supply (ie stop dementia)
Parkinson’s Disease- loss of dopamine cells, characteristic movement(s).
describe alzeihmers disease.
progressive neurodegeneration neurological syndrome
mini mental state examination - total score of 30. 20-24 pts indicate mild dementia. 13-20 pts indicate moderate dementia and <12 indicates severe dementia.
cognitive decline, impaired thinking and memory, gradual loss of skills - also changes in mood, personality and social behaviour
treatment does not modify disease progression but improves symtopsm of cognition, function and behaviour
cholinergic hypothesis: cognitive decline due to progression of loss of cholinergic neutrons and reduced anticholinergicesterases - Rx donzepil, rivastigamine, galantamine
glutamate/ NMDA receptor also indicated - memantine
describe stroke
blockage or bleeding of vessels in the brain - hypertension and increased cholesterol
describe Parkinsons
motor and non motor symptoms - drug treatment of motor symptoms.
non-motor - depression, dementia, sleep disturbances, bladder and bowel dysfunction, speech and language changes, swallowing difficulties
what is associated with anticholinergic medication ?
there is increased in the use of commonly used drugs or medications with anticholinergic burden. mild - atenolol, moderate - carbamazepine, and severe - TCAs
elderly experience more adverse effects - constipation, confusion, sedation, dry mouth/eyes, urinary retention
also increased risk of dementia with anticholinerases
how can dysphagia be tackled?
Not unique to elderly but more pronounced esp dementia, PD.
Try different formulations patches, e.g oral solution, oro-dispersible tabs.
Enteral feeding tubes – compatibility of medicine with rubber tubing, other drugs etc.
Specific resources available to guide staff e. g NEWT guidelines for administration of medication to patients with enteral feeding tubes or swallowing difficulties
what is the assessment for dysphagia?
Speech and Language Therapist- invasive via NG camera or x-ray
Advise on texture of foods/meds
Review / advise on alternatives - main concern is aspiration and choking
Specials Vs licensed alternatives
Where possible- get written confirmation/request for modification of the dosage form – not the same as concealing or giving covertly.
describe pharmacy in palliative care
an approach that improves the quality of life of patients and their families facing…life-threatening illness, through the prevention and relief of suffering…and other problems, physical, psychosocial and spiritual”
