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WEEK 7 SEM 4 > Pharmacology and older people > Flashcards

Pharmacology and older people Flashcards

1
Q

What is polypharmacy?

A

Taking 5 or more meds

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2
Q

What do statins do?

A

lower cholestrol levels in the blood

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3
Q

What are the side effects of statins?

A

muscle inflammation and myopathy

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4
Q

What is a drug error?

A

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

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5
Q

What are examples of administration errors?

A

giving to wrong person

not giving drug at all

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6
Q

What is INR?

A

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.

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7
Q

What is pharmacokinetics?

A

What the body does to the drug= ADME

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8
Q

What is pharmacodynamics?

A

How the drug affects the body

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9
Q

What are the routes of administration?

A 
oral
IV
IM
patch
nasogastric tube
rectal
liquid medications
subcutaneous
topical
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10
Q

What can affect someone’s swallowing (dysphagia)?

A

parkinson’s, stroke

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11
Q

When can it be hard to find IV access?

A

When hyperactive delirium

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12
Q

What happens in elderly that can affect absorption?

A
  • 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)
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13
Q

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

A
  • inflammatory bowel disease

- coeliac disease

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14
Q

How can drugs change the absorption?

A
  • 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
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15
Q

What happens in elderly that affects drug distribution?

A 
less body mass
more body fat
less body water
less albumin
more glycoprotein
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16
Q

When do you get low albumin in older adults?

A
  • chronic inflammation

- malnutrition

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17
Q

Where are drugs metabolised?

A

in the liver- increases watersolubility to increase its excretion

18
Q

What happens to liver in old age?

What happens as a result of this?

A

1) less size
reduction in blood flow

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

19
Q

If a person is older, what happens to eGFR?

A

lower eGFR so elimination is slower

20
Q

What happens to kidney in older person?

A

size reduce
less renal blood flow
less functioning nephrons
reduced GFR

so basically more accumulation of water-soluble drugs

21
Q

What effects do antihypertensive drugs have on the elderly?

A

reduce bp

22
Q

What are chronotropic drugs?

A

control heart rate

have a reduced response in elderly

23
Q

What problems can patients face when giving anticholinergic drugs?

A

delirium

24
Q

Which drugs give increased sedation?

A

benzodiazepenes

25
Q

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

A

bc old people have greater vitamin K inhibition

26
Q

Why isnt the prescription for elderly good?

A

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

27
Q

What is a drug for dementia?

A

cholinisterase inhibitor

28
Q

When do you do a medication review?

A
  • ADR
  • if someone is falling
  • if someone develops a new frailty syndrome
  • if someone has a new palliative diagnosis
29
Q

What is beer’s criteria?

A

gives you list of medicines you should avoid in elderly

30
Q

What is STOPP/START criteria?

A 
STOPP= drugs you should stop
START= drugs you should start
31
Q

What is the anticholinergic risk scale?

A
  • 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
32
Q

Why might a patient not take drugs?

A

cognitive problem
manual dexterity
visual impairment

33
Q

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

A

no follow up

patient doesn’t have good education

34
Q

What is absorption of a drug?

A

movement of drug from admin site to bloodstream

35
Q

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

A

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

36
Q

What happens to a lipophilic drug in old age?

A

old age, more body fat

so lipophilic drugs will distribute in fat more and stay longer

37
Q

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

A

more free drug concentration

38
Q

Why is an increased concentration of free drugs a problem?

A

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.

39
Q

Why is polypharmacy harmful?

A
  • > 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
40
Q

Risk factors for suffering an ADR

A
  • Increasing age
  • Being on multiple medications
  • Errors in drug taking
  • Previous adverse reactions
  • Low body mass index
  • Renal impairment (pharmacokinetics!)
  • Poor compliance
41
Q

How can you improve patient compliance?

A

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

WEEK 7 SEM 4 (7 decks)

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