Pharmacology and older people

Question 1

What is polypharmacy?

Answer 1

Taking 5 or more meds

Question 2

What do statins do?

Answer 2

lower cholestrol levels in the blood

Question 3

What are the side effects of statins?

Answer 3

muscle inflammation and myopathy

Question 4

What is a drug error?

Answer 4

Drug that is mis-prescribed or not administered to patients.
wrong drug
wrong dose
wrong route

Question 5

What are examples of administration errors?

Answer 5

giving to wrong person

not giving drug at all

Question 6

What is INR?

Answer 6

international normalized ratio
Healthy people= INR of 1.1 or below is normal.
An INR range of 2.0 to 3.0 = an effective therapeutic range for people taking warfarin for disorders such as atrial fibrillation or a blood clot in the leg or lung.

Question 7

What is pharmacokinetics?

Answer 7

What the body does to the drug= ADME

Question 8

What is pharmacodynamics?

Answer 8

How the drug affects the body

Question 9

What are the routes of administration?

Answer 9

oral
IV
IM
patch
nasogastric tube
rectal
liquid medications
subcutaneous
topical

Question 10

What can affect someone’s swallowing (dysphagia)?

Answer 10

parkinson’s, stroke

Question 11

When can it be hard to find IV access?

Answer 11

When hyperactive delirium

Question 12

What happens in elderly that can affect absorption?

Answer 12

• less GI motility (increase drug absorption)
• less gastric acid production (depends on drug but mostly decreases absorption bc most drugs are wear acids that need neutral stomach to be absorbed)
• less splanchic blood flow (intestines) (less drug absorption)

Question 13

What diseases are common in older people that can affect absorption?

Answer 13

• inflammatory bowel disease

- coeliac disease

Question 14

How can drugs change the absorption?

Answer 14

• antacids change the pH of stomach- increase/decrease absorption of drugs
• iron binds lots of drugs- if give with thyroxine, thyroxine is not absorbed
• omeprazole (PPI) affects absorptions

Question 15

What happens in elderly that affects drug distribution?

Answer 15

less body mass
more body fat
less body water
less albumin
more glycoprotein

Question 16

When do you get low albumin in older adults?

Answer 16

• chronic inflammation

- malnutrition

Question 17

Where are drugs metabolised?

Answer 17

in the liver- increases watersolubility to increase its excretion

Question 18

What happens to liver in old age?

What happens as a result of this?

Answer 18

1) less size
reduction in blood flow

2) reduced first pass metabolism
drugs more likely to be accumulated in the liver

Question 19

If a person is older, what happens to eGFR?

Answer 19

lower eGFR so elimination is slower

Question 20

What happens to kidney in older person?

Answer 20

size reduce
less renal blood flow
less functioning nephrons
reduced GFR

so basically more accumulation of water-soluble drugs

Question 21

What effects do antihypertensive drugs have on the elderly?

Answer 21

reduce bp

Question 22

What are chronotropic drugs?

Answer 22

control heart rate

have a reduced response in elderly

Question 23

What problems can patients face when giving anticholinergic drugs?

Answer 23

delirium

Question 24

Which drugs give increased sedation?

Answer 24

benzodiazepenes

Question 25

Why do elderly patients need lower doses of warfarin compared to young people?

Answer 25

bc old people have greater vitamin K inhibition

Question 26

Why isnt the prescription for elderly good?

Answer 26

ADR not enough clinical trial evidence for elderly compliance problems heterogenic comorbid patient group (all patients at same age are different) increased prevalence of polypharmacy

Question 27

What is a drug for dementia?

Answer 27

cholinisterase inhibitor

Question 28

When do you do a medication review?

Answer 28

- ADR - if someone is falling - if someone develops a new frailty syndrome - if someone has a new palliative diagnosis

Question 29

What is beer's criteria?

Answer 29

gives you list of medicines you should avoid in elderly

Question 30

What is STOPP/START criteria?

Answer 30

``` STOPP= drugs you should stop START= drugs you should start ```

Question 31

What is the anticholinergic risk scale?

Answer 31

- give this drug in delirium - digoxin has anticholinergic effect even though it is just an na/k pump inhibitor - there is a scale telling you how much of an anticholinergic effect each drug has

Question 32

Why might a patient not take drugs?

Answer 32

cognitive problem manual dexterity visual impairment

Question 33

Why might it be a doctor's fault if the patient doesn't take the medication?

Answer 33

no follow up | patient doesn't have good education

Question 34

What is absorption of a drug?

Answer 34

movement of drug from admin site to bloodstream

Question 35

In an older person, with a hydrophilic drug, what happens?

Answer 35

old age, less body water so hydrophilic drug e.g. alcohol it will be in less water so basically HIGH concentration

Question 36

What happens to a lipophilic drug in old age?

Answer 36

old age, more body fat | so lipophilic drugs will distribute in fat more and stay longer

Question 37

What happens with a reduction in plasma proteins in old age?

Answer 37

more free drug concentration

Question 38

Why is an increased concentration of free drugs a problem?

Answer 38

bc if it has a narrow therepeutic index, it can become an overdose and then ADRs happen e.g. phenytoin that binds strongly to albumin, if it decreases means more free phenytoin in blood and reaches toxic levels.

Question 39

Why is polypharmacy harmful?

Answer 39

- > One is more likely to have ADR - > There is more likely to be interaction between drugs - > Polypharmacy is associated with decreased compliance - > So many drugs can lead to high incidence of side effects - > Can cause a prescribing cascade, where we keep prescribing more drugs for new symptoms that keep presenting that are side effects of other drugs

Question 40

Risk factors for suffering an ADR

Answer 40

* Increasing age * Being on multiple medications * Errors in drug taking * Previous adverse reactions * Low body mass index * Renal impairment (pharmacokinetics!) * Poor compliance

Question 41

How can you improve patient compliance?

Answer 41

Specific efforts to communicate with patient - Simplify regimes - Readable labels with precise instructions - Easily opened containers Dispensing systems designed to maximize compliance Involving and engaging carers - Recognition of side-effects