prescribing and deprescribing in the elderly Flashcards
What are the main variables that affect drug action in patients
Age, genetic and immunological factors, disease (especially relating to drug elimination), drug interactions, ethnicity
What is the main reason why age affects drug action?
Drug elimination is less efficient in the elderly
How does body composition chamge affect drug metabolism?
With age, body mass porportion leans towards fat, muscle volume decreases, changing volume of distribution of the drug
What is the volume of distribution of a drug?
As drugs distribute, changes in relative % of fat and muscle change distribution
How does GFR change with age
Decreases largely
What is eGFR
Relationship between creatinine in plasma and creatinine clearance
Can drugs with the same plasma levels in young and old present different effects
Yes - Benzidiazepines like diazepam can cause more confusion in elderly
What is postural hypotension
BP drops when person gets up
What is it called when chronic diseases co-exist?
Comorbidity/multimorbidity
Relevant as it has greater potential for drug interactions
What are the most common comorbidities in diabetes?
Hypertension, neuropathy, nephropathy, CVD
What is deprescribing
Deprescribing has been defined as
‘the process of withdrawal of an inappropriate medication, supervised by a health care professional with the goal of managing polypharmacy and improving outcomes’.
What is polypharmacy and why is it an issue
the problem of patient being prescribed multiple medications.
Potential for drug interactions, and risk of confusion on how to take medications
When is deprescribing considered?
Medication review - is each medication still needed?
During hospital admission, but must be made clear that previous medication is stopped at discharge
When a new condition needs treatment
