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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
What is the STOPP-START tool
Used to indicate which medications are suitable and not suitable for the over 65s
26
When and why should you stop loperamide or codeine phosphate in the elderly
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
When and why should you stop prochlorperazine or metoclopramide
If the patient has or develops Parkinson's | as it can exacerbate it
28
When and why should you stop stimulant laxatives such as senna
If the patient has intestinal obstruction as it comes with a risk of bowel perforation
29
When should you start PPIs in the elderly
For severe reflux disease or structures Give to those over 80 on anti-platelets and SSRIs In those on aspirin and warfarin (rare)
30
When should you start fibre supplements
For those with chronic, symptomatic diverticular disease with constipation
31
when should you stop beta-blockers
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
When should CCB be stopped
``` If the patient has chronic constipation In those with class III or IV heart failure ```
33
When should anti-hypertensives be started
treat where systolic blood pressure consistently >160mmHg
34
When do you start warfarin or DOACs
If they have chronic AF | Following a DVT or PE diagnosis
35
Which side effects must you consider in the elderly population
Risk of delirium Bowel function - especially risk of constipation Dizziness and balance issues - e.g. some drugs cause postural hypotension
36
List the common anti-cholinergic side effects
``` Confusion Hallucinations Tachycardia Blurred vision Urinary retention Constipation Dizziness Falls ``` Long term there is an increased risk of dementia
37
Which drugs can have anti-cholinergic side effect
``` Parkinson’s drugs Antidepressants Anti-emetics Opiates Antipsychotics Antihistamines ```
38
What is the risk of giving multiple anti-cholinergic drugs
Increases the risk of getting the adverse effects

Ageing (7 decks)

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