Polypharmacy

Question 1

Which classes of cardiovascular drugs are used commonly in the elderly and what are some of their common side effects?

Answer 1

ACEI - Dry cough, renal impairment, hyperkalaemia, hypotension

Diuretics - Renal impairment, hypokalaemia, dehydration

Calcium channel blockers - Constipation, peripheral oedema

Beta-blockers - Postural hypotension, bradycardia

Digoxin - Nausea, bradycardia

Nitrates - Postural hypotension

Question 2

Which classes of CNS drugs are used commonly in the elderly and what are some of their common side effects?

Answer 2

Anti-depressants - Confusion, drowsiness, urinary retention, constipation, postural hypotension

Benzodiazepines - Confusion, memory impairment, drowsiness, unsteady gait, fractures, incontinence, dependence

Antipsychotics - Tardive dyskinesia, postural hypotension, urinary retention, constipation, confusion, drowsiness, EPS

Anti-Parkinsonian - Confusion, urinary retention, postural hypotension, constipation

Opioid analgesics - Constipation, drowsiness, narcosis, falls

Question 3

Which cardiovascular drugs cause the worse postural hypotension?

Answer 3

Alpha blockers
Dihydropyridine calcium channel blockers
Beta-blockers

Question 4

Why is NSAID use in CCF concerning?

Answer 4

They can cause dose-related fluid retention and precipitate acute heart failure
(via blocking prostaglandin’s vasodilatory affect in afferent arterioles)

(This does not occur at the anti-platelet dose of 100mg but at the analgesic dose of 300-900 Q4hourly)

Question 5

Why do metoclopramide and prochlorperazine cause EPS? Which is worse for that?

Answer 5

They are dopamine antagonists

Prochlorperazine because it crossing the BBB better