Pharmacology - Old Age & Falls

Question 1

Main variables taht affet drug actions in pt’s

Answer 1

Age 
Genetic factors 
Immunological factors 
Disease (esp. when influences drug elimination or metabolism e.g., kidney or liver disease)
Drug interactions 
Ethnicity

Question 2

Why is age a main variable that affects drug action

Answer 2

Drug elimination is less efficient in older people ∴ many drugs produce a greater and more prolonger effect

Question 3

Effect of changing body composition with age

Answer 3

Fat contributes a greater proportion to the body mass in the elderly; reduction in the ‘lean’ body mass, as muscle volume is decreased
Results in change in the volume of distribution of the drug

Question 4

Volume of distribution and body composition

Answer 4

Changes in the relative % of fat and lean tissue change this distribution due to different classes of drugs being attracted to spp tissues

Question 5

Effect of age on renal she ration of drugs

Answer 5

GFR falls slowly from 20 yrs. Decreases by 25% by 50 and 50% by age 75 assuming no renal disease
Many drugs are cleared by the body via the kidneys

Question 6

Dogoxin

Answer 6

Used for atrial fibrillation, less widely used since AF affects mainly older pts

Question 7

What is the renal clean ce of digoxin closely correlated with

Answer 7

Creatinine clearance

Question 8

Why is eGFR just an estimate of creatinine clearance

Answer 8

Plasma level of creatinine doesn’t directly correlate with the clearance of creatinine by the kidney

Question 9

Creatinine synthesis in elder

Answer 9

Reduced due to due to reduction in muscle mass, so we need to take that into account when estimating GFR

Question 10

Drug metabolism and hepatic enzymes

Answer 10

The activity of these hepatic microsomal enzymes declines slowly and variably with age
Increasing half-life with drugs

Question 11

Benzodiazepine in older vs younger pts

Answer 11

Produces more confusion in elderly compared to young people despite same plasma level

Question 12

Anti-hypertensives in old vs younger pts

Answer 12

Postural hypotension is much more common with the older pt. on an anti-hypertensive –> increased risk of falls

Question 13

Why are older pets at greater risk for drug interactions

Answer 13

Comorobidiities –> prescribe a no. diff drugs for one person

Question 14

What percentage of adverse drug reactions are caused by drug interactions

Answer 14

5-20%

Question 15

Examples of chronic disease in older pts

Answer 15

Alzheimer disease and other types of dementia 
Arthritis 
Asthma 
Cancer 
COPD
Diabetes 
Epilepsy 
Heart disease 
HTN 
Mood disorders (depression and anxiety)
MS 
Parkinson’s

Question 16

Cimomrbidity in HTN

Answer 16

HTN affects > 1 in 4 adults in the UK and prevalence is rising as population ages. A study found that every 2 in 3 HTN pts have a comorbidity

Question 17

Comorbidity vin diabetes

Answer 17

87% have hen
26% have nephropathy
22% have cardiovascular disease

Question 18

Why do we need to be able to justify meds precribes and regularly review the,

Answer 18

Due to effects of age on drug metabolism, clearance, side effect profile

Question 19

Deprescribing

Answer 19

The process of withdrawal of an inappropriate medication, supervised by an HCP with the goal of managing polypharmacy and improving outcomes

Question 20

How can poly pharmacy cacaos confusion

Answer 20

Confusion about how to take the med, esp. those that need to be taken more than ODS

Question 21

UK situation on polypharmavy

Answer 21

Prebvalnec is increasing

In Scotland 5/5+ prescriptions doubled and 10/10+ tripled between 1995-2010

Question 22

Which sex is polypharacy more common in

Answer 22

Female

Question 23

Poluypharmacy and asymptomatic pts

Answer 23

To prevent future illness

Incentivised in primary care when payments are made under the quality and outcomes framework

Question 24

When should deprescribing be considered

Answer 24

Med review
During hosp admission
When we need to treat a new condn

Question 25

Med review - deprescribing

Answer 25

Critical point at which we can question the need to continue with medication
You need to ask the q for every medication on the list “does this pt. still need this?”

Question 26

During hosp admission - deprescribing

Answer 26

Vital it is made clear at point of d/c that some med have been stopped, otherwise they may be accidentally restarted in the community

Question 27

Treating a new condn - deprescribing

Answer 27

Important as potential drug interactions

The potential for confusion increases with risks of the wrong dose being taken or doses being missed

Question 28

Factors leading to polypharmacy in old age

Answer 28

Multiple pathology
Poor pt education
Lack of routine review of all meds
Pt expectation of prescribing over-use of drug interventions by drs
Attendance at multiple specialist clinics
Poor communication between specialists

Question 29

Common adverse reactions to NSAIDs

Answer 29

GI bleeding and peptic ulceration

Renal impairment

Question 30

Common adverse reactions to diuretics

Answer 30

Renal impairment, electrolyte disturbance
Gout
Hypotension, postural hypotension

Question 31

Common adverse reactions to warfarin

Answer 31

Bleeding

Question 32

Common adverse reactions to ACE inhibitors

Answer 32

Renal impairment, electrolyte disturbance

Hypotension, postural hypotension

Question 33

Common adverse reactions to beta-blockers

Answer 33

Bradycardia, heart block

Hypotension, postural hypotension

Question 34

Common adverse reactions to opiates

Answer 34

Constipation, vomiting
Delirium
Urinary retention

Question 35

Common adverse reactions to antidepressants

Answer 35

Delirium
Hyponatraemia (SSRIs)
Hypotension, postural hypotension
Falls

Question 36

Common adverse reactions to benzodiazepines

Answer 36

Delirium

Falls

Question 37

Common adverse reactions to anticholinergics

Answer 37

Delirium
Urinary retention
Constipation