Polypharmacy Flashcards
Side effects of PPI use
Bone fragility C difficile infections Pneumonia ? Hypomagnesaemia Increased mortality?
What type of muscle mass is lost in sarcopenia in ageing?
TYPE 2 (fast twitch/fine motor) greater than type 1 (slow twitch, sustained motor)
Major cardiovascular changes with getting old?
Ventricular muscle stiffens
Increased LV mass
Reduced relaxation
NO CHANGE in contractility or EF at rest
Loss of atrial pacemaker cells
Loss of baroreceptor reflex
Reduced max HR- dependence on SV to increase CO
Sitting HR decreases
Greater reliance on atrial contraction (approx 30% cardiac output)
Afterload increased due to stiffening of vessels - DBP rises 30-60, systolic increases with age
Decrease beta receptors so less response to beta adrenergic stimulation
Exercise conditioning increases SV and o2 utilisation
Resp system changes with age?
DLCO declines FEV1 declines FVC declines, but less Increase VQ mismatch Increased bronchodilator response Reduced drive with hypoxia and hypercarbia Stiffer chest waall REduced elastic recoil
Renal changes in old people?
Reduced renal mass- the cortex more than the medulla
Reduce glomeruli
Sclerotic changes
Reduced blood flow 10% per decade
Reduced max and min osmolality
GFR reduced 8ml/min per decade from 45 years
Urinary tract in old people?
Variable reduction in bladder capacity
Bladder changes in old people?
Reduced bladder capacity Reduced bladder contractility Increased detrusor hyperactivity Reduced outflow resistance in women Nocturia
Liver in old people?
Reduced volume, weight, blood flow
Note need 70% reduction in hepatic reserve to be significant
No change in LFTs with age
LEss than 10% decline in clearance related to perfusion rather than induction/inhibition of metabolism
Changes in drug metabolism in old people?
Slower absorption - reduced bioavailability
Reduced vol distribution
Reduced renal more than hepatic clearance
Increased half life
Immune system changes in old people?
Impaired T helper cells–>humeral changes
Ig overall stable but increase A, G, and decreased D and M
Reduced antibody response
Need larger antigenic stimulus, and response not as large
Increase in monoclonal Igs not associated with myeloma after 70
Less diurnal variation in temperature
Reduced temp response to Il1, 6, TNF
Endocrine changes in old age?
Insulin resistance Increase PTH Increase ADH--> increase hyponatraemia Increase ANP with increase in intravascular volume Rise in FSH and LH
Use of antipsychotics in the elderly leads to what?
Increased risk of stroke and thromboembolism
main side effects SSRI
GI
bleeding from plt dys
falls
hyponatraemia
SNRI side effect
headache
gi
diaphoresis, dry moouth
hypertenison
TCA side effects
falls risk dry eyes, urinary retention, constipation weight gain cardiac arrhythmia sedation
TCA MOA
NA and serotonin reuptake inhibitors and GABA-A blockers
in overdose, cardiotoxic from block fast sodium channels
seizure and coma before cardiotoxicity
bicarb promotes TCA binding to plasma proteins
VZV hibernates in
sensory ganglia
Suspect VZV in aseptic meningitis?
anti VZV ab in csf more sensitive than blood and bost better than PCR assay
Famciclovir in VZV?
reduced time to new lesions
reduce time to loss vesicles and full crusting
quicker cessation viral shedding
faster pain resolution
Intrials given within 72 hours but some evidence if still new vesicles
NOT CLEAR if reduce post herpetic neuralgia
acute zoster pain?
vs post herpetic neuralgia?
NSAIDS, panadol
next opioids
post herp: topical lidocaine, pregabalin, opioids, TCA, capsaicin
In AU who gets zoster vaccine
single dose all people over 60 doesnt matter if chicken pox history
Not if preg, HIV under 200, pred more than 20 for 2 weeks, anti TNF therapy, chemo last 3 months, haem malig active
Au guidelines who gets famcic or valacic or acic?
The former two are better for pain
all people less than three days
all immunocompromised- if systemic IV aciclovir
is there diurnal variation in fibromyalgia?
No
What is the new concept with american lipid profiles?
That it is your CV risk at baseline rather than LDL at baseline that determines magnitude of benefit for statin therapy. Reduce risk 20% from baseline.
