Medication Usage in Older Adults

Question 1

Define an adverse drug event

Answer 1

-unfavourable occurrences related to the use or misuse of medication

Question 2

Define an adverse drug reaction

Answer 2

-adverse events/effects of a drug that was used in correct dose for appropriate use

Question 3

Pharmokinetics

Answer 3

-what the body does to the drug

Question 4

Pharmodynamics

Answer 4

-what the drug does to the body

Question 5

Basic pharmokinetics?

Answer 5

1. Absorption-small intestine
2. Distribution
3. Metabolism-chewed up and changed-liver
4. Excretion-kidney, urine

Question 6

What happens with elderly? 6 effects

Answer 6

1. Decreased renal function
   =stays in body longer
2. decreased liver function
   =cannot metabolize as well-longer half life
3. less body water
4. increased fat
   =meds that are lipid soluble are stored-elevates effect
5. decreased stomach acid
   =slowed absorption
6. decreased cardiac output, impaired circulation
   =not moved around body as efficiently

Question 7

Reasons for polypharmacy in elderly? 4 points

Answer 7

• Co morbid conditions
• Multi drug regimens
• More over the counter drugs
• Multiple health care providers involved

Question 8

Prescribing cascade?

Answer 8

-when an adverse drug event occurs, but is not attributed to the drug, and then they go on another drug to compensate for adverse event

Question 9

Indicators of polypharmacy?

Answer 9

• meds with no indication
• multiple meds of same class
• drug interactions

Question 10

Prevention and treatment of polypharmacy

Answer 10

1. consult pharmacist
2. weigh the risks and benefits
3. consider med appropriateness in later life

Question 11

Guidelines for improving prescribing in the elderly?

Answer 11

-Bears and STOPP/START criteria

Question 12

Examples of medications to avoid?

Answer 12

• NSAIDs
• Muscle relaxants
• Benzodiazepines
• cholinergic
• Estrogens

Question 13

Antipsychotics in the eldery

Answer 13

• Non drug therapy is first line

- 1 patient in every 52 treated die with antipsychotics

Question 14

How to improve medication adherence?

Answer 14

• Simplify regimen
• Simple, clear instructions in large print
• Compliance packing
• Alarms
• Support from family

Question 15

Nova Scotia Pharmacare program

Answer 15

• Resident of NS
• 65 or older
• No coverage of another kind
• Have to enroll!! not automatic

Question 16

How to prevent adverse drug events?

Answer 16

• Consider pharmokinetic changes with aging
• Avoid polypharmacy when possible
• Avoid prescribing cascade
• Avoid inappropriate meds
• Consider drug interactions
• Aim for simple, cost effective regimens