Polypharmacy Flashcards
Give some reasons why the elderly are at higher risk of Adverse Drug Reactions (ADRs) (6)
Polypharmacy (≥4) ≥ 4 Co-morbidities Dependant living situation Impaired renal func Impaired congition Non-adherance
Whats the diff b/wn pharmacodynamics + pharmacokinetics
Dynamics = drugs interaction w. body Kinetics = what body does to drug (Absorption/Distribution/Metabolism/Excretion)
What drugs may elderly people have increased sensitivity to (re: pharmacodynamics) (6)
+ Reduced sensitivity to (3)
Neuroleptics / BZDs / Opiates / TCAs
Antihypertensives
Warfarin
B-blockers / B-agonists
Furosemide
How does ageing affect volume of distributions (3)
How does ageing affect hepatic metabolism (3)
How does ageing affect renal elimination (1)
Increased VoD for fat-solubles (less body fat)
Reduced VoD for water-solubles (more body water)
Increased effect of albumin-bound drugs (less albumin)
Reduced liver vol
Reduced hepatic flow
Reduced P450 activity
GFR reduces with age
How are the ageing effects on hepatic/renal metab/elimination controlled?
Reduce doses / shorter dosing intervals
-> Prevent toxic accumulations
List some renal excreted drugs that have a narrow TW (4)
Lithium
Digoxin
Gentamicin
Vancomycin
List the considerations to be made in a medication review (7)
Can any be stopped / Are high-risk drugs necessary Up-to-date with current evidence? To be monitored: SEs Therapeutic goals INR // GFR/CrCl // Blood count etc
List the considerations to be made when commencing a new drug (7)
Necessary?
Being used to treat an ADR?
Narrow TW
Low starting dose required?
Dose modification needed (due to elimation route)
New drug - interactions w. existings?
Could new drug worsen existing pathology?
What are the most important drugs to STOPP (5) + START (5)
STOPP: Amitryptiline Prednisolone Paracetamol Codeine Morphine
START: Salbutamol ACEis Warfarin Simvastatin Bisphosphonates
