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 (mild-moderate impairment; severe impairment)
- Enoxaparin
- Co-amoxiclav
- DOAC
- Morphine to oxycodone if mild-moderate; buprenorphine or alfentanil if severe
- 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).
