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Ageing > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

What is pharmacokinetics

A

How the body deals with a drug once administered

Involves absorption, distribution, metabolism and excretion

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2
Q

What is pharmacodynamics

A

How the drug acts on the body

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3
Q

How does pH of a drug affect its absorption

A

Acidic drugs need an acidic environment to be absorbed

Same is true for basic drugs

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4
Q

List examples of acidic drugs

A

Phenytoin
Aspirin
Penicillins

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5
Q

List examples of basic drugs

A

Diazepam
Morphine
Pethidine

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6
Q

Elderly patients absorb proportionally more basic drugs - why?

A

They secrete less stomach acid so less of an environment for acidic drugs to be absorbed

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7
Q

Why might elderly patients have less effective drug absorption

A

Less acid due to natural atrophy of parietal cells

Smaller surface area in the small intestine

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8
Q

Why must you consider drug delivery in elderly people

A

Need to take dysphagia into account for delivery - may need liquids
Consider NG/PEG tubes
Some may be NBM

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9
Q

Why do elderly patients have longer drug half lives?

A

The renal and hepatic clearance decreases which increases the half life – drug stays in system much longer
Elderly also have more fat so higher lipid sequestration

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10
Q

Higher fat to muscle content in elderly patients has what effect on drugs?

A

It increases the volume of distribution of lipophilic drugs and therefore increases their half life

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11
Q

What molecule binds acidic drugs in the body

A

Albumin

It is itself basic

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12
Q

What molecule binds basic drugs in the body

A

Alpha-1 Acid Glycoprotein

It Is itself acidic

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13
Q

How is hepatic metabolism affected by ageing

A

Reduced liver function due to decreased size,
blood flow, and disease

Reduction in first pass metabolism
Enzyme activity can also be reduced

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14
Q

How is renal metabolism affected by ageing

A

They will have decreased number of nephrons, size, tubular secretion and blood flow
Reduced GFR as a result

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15
Q

Why must you be careful using drugs with a narrow therapeutic index

A

Fine line between effective dose and lethal dose

Need to closely monitor

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16
Q

Give examples of drugs with a narrow therapeutic index

A 
Theophylline
Warfarin 
Digoxin 
Vancomycin 
Gentamicin
17
Q

Which drugs most commonly cause adverse side effects in the elderly

A 
Warfarin 
Digoxin 
Insulin 
Benzodiazepines 
Diuretics 
NSAIDs
18
Q

What extra precautions should you take when starting opioids

A

Start lactulose or senna as prophylactically

Opioids cause significant constipation which can be dangerous in the elderly

19
Q

What extra precautions should you take when starting steroids (long-term)

A

Long term use may need osteoporosis prevention

Need to monitor blood sugar regularly to watch for steroid induced diabetes

20
Q

If taking levothyroxine, which other drug should be avoided

A

Calcium

It interferes with the absorption of levothyroxine

21
Q

What are the major side effects of NSAIDs

A

GI haemorrhage
Decline in GFR
Decreased effectiveness of diuretics and anti-hypertensives

22
Q

What are the major side effects of benzodiazepines and opioids

A

impaired psychomotor function

falls and confusion (should do fall assessment before prescribing)

23
Q

What is the major risk with prescribing antibiotics in the elderly

A

Resistance

C diff infection - diarrhoea

24
Q

How can we help reduce polypharmacy in the elderly population

A

Review medication regularly
Avoid treating drug side effects with more drugs
Try and find a drug that will treat more than one clinical problem
If stable, try a combination tablet

25
Q

What is the STOPP-START tool

A

Used to indicate which medications are suitable and not suitable for the over 65s

26
Q

When and why should you stop loperamide or codeine phosphate in the elderly

A

If treating diarrhoea of unknow cause because it can cause constipation, overflow diarrhoea, toxic megacolon and delay recovery from gastroenteritis

If treating severe gastroenteritis it can exacerbate the infection

27
Q

When and why should you stop prochlorperazine or metoclopramide

A

If the patient has or develops Parkinson’s

as it can exacerbate it

28
Q

When and why should you stop stimulant laxatives such as senna

A

If the patient has intestinal obstruction as it comes with a risk of bowel perforation

29
Q

When should you start PPIs in the elderly

A

For severe reflux disease or structures
Give to those over 80 on anti-platelets and SSRIs
In those on aspirin and warfarin (rare)

30
Q

When should you start fibre supplements

A

For those with chronic, symptomatic diverticular disease with constipation

31
Q

when should you stop beta-blockers

A

If the patient is also on verapamil as there is a risk of symptomatic heart block

Non-cardioselective ones should be stopped in those with COPD as there is a risk

32
Q

When should CCB be stopped

A 
If the patient has chronic constipation 
In those with class III or IV heart failure
33
Q

When should anti-hypertensives be started

A

treat where systolic blood pressure consistently >160mmHg

34
Q

When do you start warfarin or DOACs

A

If they have chronic AF

Following a DVT or PE diagnosis

35
Q

Which side effects must you consider in the elderly population

A

Risk of delirium
Bowel function - especially risk of constipation
Dizziness and balance issues - e.g. some drugs cause postural hypotension

36
Q

List the common anti-cholinergic side effects

A 
Confusion
Hallucinations
Tachycardia
Blurred vision
Urinary retention
Constipation
Dizziness
Falls

Long term there is an increased risk of dementia

37
Q

Which drugs can have anti-cholinergic side effect

A 
Parkinson’s drugs
Antidepressants
Anti-emetics
Opiates
Antipsychotics
Antihistamines
38
Q

What is the risk of giving multiple anti-cholinergic drugs

A

Increases the risk of getting the adverse effects

Ageing (7 decks)

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