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Ageing > Pharmacology/prescribing > Flashcards

Pharmacology/prescribing Flashcards

1
Q

Why do lipiphilic drugs such as anaesthetics/diazepam have a longer half life in older people?

A

Greater volume of distribution due to increased fat:muscle ratio

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2
Q

Why is GFR generally reduced in the elderly?

A

Decreased size, lower renal blood flow

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3
Q

What is the drawback of the MDRD equation for older people?

A

Older people have lower muscle mass, hence MDRD tends to over-estimate eGFR

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4
Q

What happens to the therapeutic index for drugs such as warfarin, lithium in older people?

A

Becomes narrow

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5
Q

How is the therapeutic index calculated?

A

LD50/ED50 (the median lethal dose over the median effective dose)

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6
Q

Erythromycin and clarithromycin are examples of…

A

Macrolide antibiotics

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7
Q

Interactions of macrolides? (2)

A

Theophylline

Statins

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8
Q

Key warfarin interactions (increase the INR) (7)

A 
NSAIDs
Cimetidine
SSRIs
Various antibiotics (metronidazole, macrolides, tetracyclines)
Antiplatelets
Cranberry juice
Acute alcohol intoxication
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9
Q

What is the most potent enzyme inducer that reduces the INR of a person on warfarin?

A

Rifampicin

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10
Q

The hypoglycaemic effect of sulfonylureas is increased by which class of drug?

A

ACE inhibitors

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11
Q

Clopidogrel and PPI- effect?

A

Inhibits the effect of clopidogrel

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12
Q

Rare adverse effect of chloramphenicol?

A

Bone marrow suppression

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13
Q

What are the four drugs most commonly associated with adverse reactions in the elderly?

A

Warfarin
Digoxin
Insulin
Benzos

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14
Q

Problems with NSAIDs particularly in older people?

A

GI bleed risk, decline GFR, decreased effectiveness of anti-hypertensives and diuretics

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15
Q

Adverse effects of using antibiotics in older people without clinical evidence of infection?

A

C diff

Resistance

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16
Q

Why is hypovolaemia in response to diuretics more likely in older people?

A

Blunted thirst response

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17
Q

Examples of drug-disease interactions? (2)

A

Drugs with anticholinergic properties- precipitate urinary retention in men with prostatic hyertrophy
Benzodiazepines can precipitate delirium in a patient with dementia

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18
Q

What is the danger of oral hypoglycaemics in older patients? How can this be prevented?

A

Increased susceptibility to hypos, and decreased awareness of them. Avoid using longer-acting formulations, start low and go slow

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19
Q

Uncontrolled hypertension + renal bruit…?

A

Renal artery stenosis

20
Q

Which commonly-prescribed class of drugs should be used with extreme caution in renal artery stenosis?

A

ACE inhibitors- precipitate renal failure

21
Q

Monitoring for older patients being started on ACE inhibitors?

A

Baseline eGFR and electrolytes, before starting and before increasing doses

22
Q

Co-morbidity which increases risk of ACE inhibitor-induced hypotension?

A

Aortic valve stenosis

23
Q

Which electrolyte disturbance is a side effect of ACE inhibitor therapy, and concurrent prescription of which drugs enhances this risk?

A

Hyperkalaemia

Potassium sparing diuretics e.g. spironolactone

24
Q

When can the tendency to hyperkalaemia of ACE inhibitors be useful?

A

When also on a potassium-losing diuretic, e.g. furosemide or bendroflumothiazide

25
Q

Amiodarone interactions? (2)

A

Increases the effect of warfarin

Increased myopathy risk with statins

26
Q

Adverse effects of amiodarone? (7)

A 
Deranged TFTs in either direction
Nausea and anorexia
Photosensitivity
Corneal microdeposits (reversible)
Pulmonary fibrosis/alveolitis/pneumonitis
Peripheral neuropathy
Deranged LFTs
27
Q

Indications for amiodarone?

A

Rate control, prevention of supraventricular tachyarrythimias (e.g. fast AF), prevention of paroxysmal ventricular tachyarrythmias

28
Q

Adverse effects of NSAIDs in older people? (3)

A

Fluid retention
Renal toxicity- risk of acute tubular necrosis
Peptic ulceration –> GI bleeding

29
Q

What are the consequences of fluid retention in older people? (3)

A

Worsening hypertension
Worsening heart failure
Ankle swelling

30
Q

Which group of drugs should you avoid co-prescribing NSAIDs with?

A

ACE inhibitors- increases the likelihood of renal toxicity

31
Q

Guidance for NSAID use in older people?

A

Use with extreme caution, avoid altogether in the very frail
Short periods, low dose, moderate potency
Avoid using two together (including aspirin)

32
Q

What should you consider co-prescribing with NSAIDs in an older patient?

A

omeprazole

33
Q

Potential issues with opioid analgesia in older people?

A 
Constipation
Nausea and vomiting
Confusion
Drowsiness
Toxicity (respiratory depression)
34
Q

Conditions for which oral steroids are commonly prescribed in older patients? (4)

A

COPD exacerbations
Colitis
Polymyalgia rheumatica
Rheumatoid arthritis

35
Q

Bone protection for older patients on long-term (i.e. more than 2 weeks) steroids? (2)

A

Daily calcium and vitamin D

Bisphosphonate (daily/weekly)

36
Q

Which basic clinical measurements should be monitored regularly when patients are on long-term steroids?

A

Blood glucose

Blood pressure

37
Q

Why does increased blood pressure occur when treated with prednisolone?

A

Mineralocorticoid effect

38
Q

Skin changes with steroid use? (4)

A

Purpura
Bruising
Skin thinning and fragility
Striae

39
Q

Pattern of myopathy with steroid use?

A

Mostly proximal, causing problems such as rising from chairs

40
Q

Why should steroids be given mane if possible?

A

Can cause acute confusion and sleep disturbance

41
Q

Infections which are particularly common in long-term steroids?

A

Oral and genital candidiasis

42
Q

Steroid rules for acute illness?

A

Double the usual oral dose; replace with IM hydrocortisone if NBM

43
Q

Which condition can be “masked” by steroid use?

A

Peritonitis and/or perforation

44
Q

Absolute indications for warfarin? (3)

A

PE
DVT
Heart valve replacement

45
Q

Relative indication for warfarin?

A

Stroke prophylaxis in AF

Ageing (10 decks)

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