Polypharmacy Flashcards
What are the 5 frailty syndromes in the elderly? [5]
Falls: Such as collapse, legs giving way, or being found on the floor
Immobility: Such as a sudden change in mobility, or being “stuck in the toilet”
Delirium: Such as acute confusion, sudden worsening of confusion, or “muddledness”
Incontinence: Such as a change in continence, or new onset or worsening of urine or faecal incontinence
Susceptibility to side effects of medication: Such as confusion with codeine, or hypotension with antidepressants
Which medications increase the risk of falls? [6]
- Sedatives
- Antihypertensive medications
- Drugs that prolong QT interval
- Drugs that cause delirium
- Drugs that reduce vision
- Postural hypotension
- Drugs causing Hypoglycaemia
What are the three types of anticholinergics? [3]
Blocks action of Acetylcholine at synapses in CNS + PNS
Divided into 3 categories:
* Antimuscarinic agents
* Ganglionic blockers (nicotinics)
* Neuromuscular blockers
What are common (unwarranted) anticholinergic effects? [3]
- Dry mouth, constipation and urinary retention
- Linked to poor cognition and physical decline
- Associated with falls, and increased mortality and cardiovascular events.
Name 5 medications that can cause constipation
Antacids
Antimuscarinics
Antidepressants
Anti-epileptic medications
Antipsychotics
Calcium supplements
Diuretics
Iron supplements
Opioids
Paracetamol
Amlodopine
The most common medications to cause delirium are: [3]
Opiates
Benzodiazipine medications
- Given to older patients due to insomnia
Anti-cholinergic medications
What are BP targets in over 80s? [1]
< 150/90 if over 80
What are common drug ADRs of B blockers? [3]
Bradycardia
Heart block
Hypotension
Wheezing
What are common drug ADRs of opiates? [3]
Constipation
Vomiting
Confusion
Urinary retention
What are clinic [1] and ABPM [1] BP targets in over 80s?
Clinic: < 150/90
ABPM: < 145/85
Why do you need to be careful about codeine / opiates with a patient who is had vomiting / diarrhoea? [1]
Opiates are renally excreted.
If fluid loss, might be in AKI - in which case need to change medication away from opiates
How would you alter the below if a patient has become renally impaired?
- Morphine
- Enoxaparin
- Co-amoxiclav
- DOAC
- Morphine to oxycodone
- Enoxaparin - reduce dose to 20mg if CrCl is 15-30
- Co-amoxiclav - reduce dosing
- DOAC - not licensed below CrCl 15; reduce dosing -
Why are the elderly more susecptible to anticholinergic effects of drugs? [1]
Increased perm. of BBB
Which drug could you use instead of oxybutynin? [1]
E.g. in the elderly
Mirabegron
A patient with dx PD becomes NBM.
Why is this critical and how would you treat them? [1]
Time critcal to ensure that get PD tx
- if NBM can give via NG tube or switch to rotigotine patch
For each of the following, state a side effect [5]
When calcuting Anticholinergic Burden Scale (ACB), a score of [] or more is considered clinically relevant
3 +
START
Start [] in patients taking maintenance oral
corticosteroid therapy
GM
Bisphosphonates in patients taking maintenance oral
corticosteroid therapy
Which hypertensive levels should you stop NSAIDs on in the elderly?
with moderate-severe hypertension (moderate: 160/100mmHg –
179/109mmHg; severe: ≥180/110mmHg) (risk of exacerbation of
hypertension).
Diclofenac is associated with
[body system] risks that are higher than the other non-selective NSAID
Diclofenac is associated with
cardiovascular risks that are higher than the other non-selective NSAID
Urogenital System BNF Chapter 7
Do NOT offer [] (immediate release) to frail older
women.
Do NOT offer oxybutynin (immediate release) to frail older
women.
In whcih conditions are bladder antimuscarinic drugs recommended to stop in CoE? [4]
STOP:
Bladder antimuscarinic drugs
with dementia (risk of increased confusion, agitation).
with chronic angle-closure glaucoma (risk of acute
exacerbation).
with chronic constipation (risk of exacerbation)
with chronic prostatism (risk of urinary retention).
When should alpha blockers be stopped in CoE? [1]
in males with frequent incontinence i.e. one or more episodes
of incontinence daily (risk of urinary frequency and worsening
of incontinence).
Which drugs are potentially inappropriate in persons aged ≥65 years of age with Parkinsoniasim, which regards to the GI system [2]
Prochlorperazine or metoclopramide with Parkinsonism (risk
of exacerbating Parkinsonism).
NB: both are dopamine agonists
During an acute illness, which DMT2 medications should be withheld? [1]
Why? [1]
If hospitalised for major surgery or acute serious illnesses
- Treatment may be restarted once the patient’s condition has stabilised and they are
eating normally for at least 24 hours
Stop BB x which drug to minimise risk of symptomatic heart block [1]
Beta-blocker in combination with verapamil
The three acetylcholinesterase (AChE) inhibitors donepezil,
galantamine and rivastigmine are recommended as options for managing
mild to moderate Alzheimer’s disease. Start with treatment of lowest
acquisition cost (currently []).
The three acetylcholinesterase (AChE) inhibitors donepezil,
galantamine and rivastigmine are recommended as options for managing
mild to moderate Alzheimer’s disease. Start with treatment of lowest
acquisition cost (currently donepezil).
