Polypharmacy in the elderly Flashcards
Define polypharmacy
The use of 5 or more medications at the same time
What is polypharmacy appropriate?
When all medications prescribed has a specific thereaptuic objective that is still relevant
Optimsied to prevent adverse drug reactions and avoid interactions
What are some of the problems with polypharmacy?
One or more medications prescibed for reasons that do not match their clinical indications (either no longer needed or prescription error)
This can increase risk of adverse patient outcomes, side effects and drug interactions.
Inc risk of poor adherence to meds
Pharmacokiniestics change in older patients - un-updated drugs can change their usefulness.
What are the consequences of adverse drug reactions from polypharmacy in the elderly?
More common in older people due to pharmacodynamic/kinetic changes e.g reduced renal clearance
Commonly from NSAIDS and diuretics
Can lead to poor health and additional hospital admissions
Common to see older patients come in with a fall secondary to low BP - often orthostatic hypotension - partially contributed to by drug side effects.
What are the consequences of drug interactions from polypharmacy in the elderly?
When a patient experience a response to two or more drugs that react with each other - a common side effect is more likely to occur, a response that is not typical when the drug is used in isolation may also occur
More medication = more chances of drug interactions
What are some common examples of drug interactions in polypharmacy?
ACEi + K-sparing diuretcis -> renal impairement and hyperkalemia
Statins + clarithromycin -> increased statin toxicity -> rhabdomyolysis
How does polypharmacy lead to poor adherence to meds in the elderly?
Not taking medication as prescribed, wrong doses/times/methods/not at all
More meds - harder to keep track -. rapid reduction in adherence as the number of medications increased
Can be made worse by self-neglect or cognitive impairment in the elderly.
What are some examples of changes to pharmacokinetics in the elderly?
Absoption rate is slower -> peak serum concentration of a drug many be lower ot take more time to take effect.
Less body water -> water soluble drugs have lower distribution volumes
Increased fat stores -> lipophilic drugs have increased distribution
Reduced hepatic blood flow - reduced metabolism and elimination
Reduced renal bf and size - reduced eGFR -> reduced elimination
What factors can help prevent irresponsible polypharmacy in the elderly?
Regular medication reviews
Non-pharmacological interventions - lifestyle changes/social groups
Changing form of medication - tablet to liquid
Lower doses - start low and go slow
Nomad packs to help with adherence
Education and support -> help patients understand what they’re taking and why.
What is the STOPP/START de-prescribing criteria?
Screening tool of older persons prescription to alert to the right treatment
Commonly used to aid medication reviews
Aims to optimse the impact and reduce the number of side-effect/waste from medication
Identify medications with more risks than benefits
Based on evidence from older patients - which is not often replicated in clinical trials
What is the use of ACB score for drugs?
Indicates the anticholinergic drug burden from two or more drugs.
A score of 3 or more indicates an increased risk of anticholinergic toxicity.
What are some side effects of high anticholinergic toxicity?
Eyes - blurred vision and dry eyes
Brain - drowsiness, dizziness, confusion and hallucination
Heart - rapid
Bladder - urine retention
Skin - flushing, overheating
Bowel - constipation
Commonly leads to increased risk of falls and increased mortality.
What are some example drugs with a high anti-cholinergic burden?
Anti-histamines
TCA
Anti-muscarinic bladder drugs
Over-the-counter travel sickness medicine: (hyoscine hydrobromide).
Sleep aids such as doxylamine
What are the side effects of bisoprolol?
What is bisoprolol?
Is a selective beta 1 blocker
Cautious in First degree AV block or obstructive airway disease, contraindicated in asthma
Side effects: constipation, abdominal pain, bradycardia, confusion, depression, dizziness, dry eyes.
What are the side effects of apixaban?
What are the contraindication?
Contraindications - active bleeding, antiphospholipid syndrome
Side effects: Anaemia, haemorrhage, nausea, skin reactions
What are the side effects and contraindications of warfarin?
Contraindications - avoid 48hrs post partum, haemorrhagic stroke, significant bleeding
Common side effects - haemorrhage, bruising, anaemia rare = alopecia, nausea and vomiting
What are the side effects and contraindications of CCB such as verapamil?
Contra-indicated if AF associated with an accessory conducting pathway
Common = abdo pain, dizziness, drowsiness, flushing, headache, nausea, vomiting, palpitations, peripheral oedema,
What are the side effects of the ACEi ramipril used to treat heart failure?
Cough
Dizziness
Renal impairement
What are the side effects of bisoprolol the beta blocker used in heart failure?
Dizziness
Headaches
Fatigue
What are the side effects of the loop diuretic furosemide used to treat heart failure?
Polyuria
Dizziness
Dry mouth
Headaches
What are the side effects of the aldosterone antagonist spironolactone used to treat heart failure?
GI disturbance
Hyperkalaemia
What are the side effects of paracetamol used for pain management?
Gi disturbance
Pruritis
What are the side effects of ibuprofen used for pain management?
Is an NSAID
GI disturbance
Increased risk of a GI bleed
Renal Impairement
What are the risks of codeine used for pain management?
Constipation
Lethargy
Confusion
What are the side effects of morphine used for pain management?
Constipation
Lethargy
Confusions
Poor renal clearance
What are the side effects of amitriptyline a tricyclic antidepressant used for pain management?
Lethargy
Anticholinergic syndrome
QT prolongation
What are the side effects of sertraline an SSI used for treating depression?
Initial worsening of depression
Lethargy
Poor concentration
GI disturbance
What are the side effects of metformin used to treat diabetes?
What is the drug class?
Is a biguanide
Causes GI distrubrnace, renal impairement, lactic acidosis
What are the side effects of rapid actin insulin such as (Humalog) to treat diabetes?
Lipodystrophy to administration site
What are the side effects of dapagliflozin? (SGLT2 inhibitor)
used to treat HF and DM
Hypoglycemia
increased risk of UTI
Back pain
What are the side effects of lingaliptin a DPP-4 inhibitor used to treat Diabetes Mellitus?
Cough
Doesn’t usually cause hypoglycemia
What are the side effects of gliclazie, a sulfonylurea used to treat Diabetes Mellitus?
Gi disturbance
Hypoglycemia
What are the side effects of a AChEsterase inhibitor such as donepezil used in dementia treatment?
Nausea
Dizziness
Sleep disturbance
What are the side effects of an NMDA inhibitor such as memantine used to treat dementia?
Constipation
Hypertension
Drowsiness
What are the side effects of oxybutynin used to treat urinary incontinence?
Antimuscarinic
Dry mouth
Blurred vision
Constipation
Urinary retention
What are the common side effects of atorvastatin?
Muscle aches
Deranged LFTs
What are the common side effects of SABAs e.g salbutamol?
Tremors
Tachycardia
What drug class is alendronic acid?
What are the side effects?
Is a biphosphonate
Causes GI distrubance, indigestion and headaches
Inc risk of spiral fractures in the long bone diaphysis
What are the side effects of Adcal-D3 for osteoporosis treatment?
What class is it?
Is a calcium with vitamin D analogue
Causes mild GI disturbance
