Medicines - Older People Flashcards

1
Q

State 2 changes that occur with ageing.

A

Progressive loss of functional capacity e.g. renal, hepatic, cardiac, respiratory. Changes in response to receptor stimulation. Reduction in body water, increase in fat content.

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2
Q

What is pharmacokinetics?

A

What the body does to the drug e.g. absorption, distribution, metabolism.

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3
Q

What is the formula for the volume of distribution?

A

Total amount of drug in the body divided by the total drug concentration.

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4
Q

Why is increased total body fat dangerous?

A

Increases in the Vd for fat soluble drugs, increases half-life and increases toxicity.

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5
Q

Why is decreased total body water dangerous?

A

Decreases Vd for water soluble drugs, means it’s more concentrated so it increases toxicity.

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6
Q

Why is a decrease in serum albumin (protein) dangerous?

A

Drugs highly bound to plasma protein, increase its drug concentration and increase its toxicity.

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7
Q

What causes a decrease in serum albumin (protein)?

A

Frailty. Malnutrition. Post-surgery renal impairment.

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8
Q

What hepatic changes occur during ageing?

A

Hepatic flow decreases. Size of liver decreases. Reduced liver enzyme activity.

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9
Q

What happens to hepatic drug clearance during ageing, and why is this dangerous?

A

Drug clearance reduced. Increases toxicity.

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10
Q

What happens to the renal system during ageing?

A

Drug clearance is excretion. Increases toxicity.

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11
Q

What two things are used to determine correct dose in ageing?

A

Glomerular Filtration Rate (GFR). Creatinine Clearance (CC).

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12
Q

What is the index where small differences in dose/blood concentration may lead to dose/blood concentration dependence?

A

National Therapeutic Index (NTI).

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13
Q

Which drugs should you avoid prescribing (nephrotic drug - high on NTI)?

A

NSAIDs e.g. aspirin.
celecoxib, diclofenac, ibuprofen, indomethacin. Angiotensin-converting enzyme inhibitor (ACEI) e.g. Benazepril, Captopril, Enalapril.

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14
Q

What is meant by pharmacodynamics?

A

What the drug does to the body.

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15
Q

State 2 organ/system changes during ageing.

A

Reflex tachycardia e.g. postural hypotension. Poor postural control - falls. Structural/neurochemical changes in CNS - reduced dopamine. Impaired thermoregulation - hypothermia. Reduced visceral muscle function - constipation, urinary incontinence.

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16
Q

State 3 adverse drug reactions (ADR).

A

GI and haematological reactions. Falls. Delirium. Motor symptoms.

17
Q

Which drugs have a narrow TI and require a lower dose?

A

Warfarin (otherwise bleeding). Digoxin (otherwise confusion). Benzodiazepine (otherwise prolonged sedative effect). Prednisolone (steroid medication - otherwise diarrhoea).

WHAT THE DRUG IS USED TO TREAT DOES NOT NECESSARILY RELATE TO THE SYMPTOMS WHEN THE PATIENT EXPERIENCES TOXICITY.

18
Q

State 3 causes of Adverse Drug Reactions.

A

Polypharmacy (multiple sorts of medications). High risk drugs. Psychoactive drugs. Number of drugs.

19
Q

What is meant by de-prescribing?

A

The safe and effective cessation (withdrawal) of inappropriate medication.

20
Q

What is meant by the prescribing cascade?

A

Misinterpretation of Adverse Drug Reactions, resulting in subsequent prescriptions of a second drug.

21
Q

What is meant by adherence?

A

The extent to which a patient follows medical advice/treatments.