Prescribing and Polypharmacy Flashcards
Acidic drugs bind to what molecule in the body?
Basic drugs bind to what molecule in the body?
Typically, what are the quantities of these binding molecules in the elderly?
Albumin
Alpha 1 acid glycoprotein
They often have low albumin, but high A1AG
In older people there is increased fat in proportion to muscle mass - what is the effect of this?
In older people there is often decreased body water - what is the effect of this?
There is an increased volume of distribution for lipophilic drugs, so they have a longer half life
There is a decreased volume of distribution for hydrophilic drugs, so they have a shorter half life
In the elderly, there is often decreased liver function. What is the effect of this?
In the elderly, there is often a lower GFR. What is the effect of this?
Decreased first pass metabolism
Decreased renal excretion
On the whole, in elderly people lower doses of drugs achieve the same effect. However, what is an exception to this rule?
Beta blockers will have decreased effect in the elderly
What is a common side effect of opioid medications?
What should be prescribed prophylactically alongside these to avoid this?
Opioids and benzodiazepines are also well known for causing what other side effects in the elderly?
Constipation
A laxative (lactulose or senna)
Falls and confusion
What metabolic problem can steroids cause?
If steroids are to be used long term, prophylaxis against what should be given?
Diabetes
Osteoporosis
Levothyroxine should not be prescribed alongside what other drug?
Why is this?
Calcium
Ca++ causes decreased absorption from the GI tract and so decreases absorption of levothyroxine
What are the main reasons for trying to avoid NSAID use in the elderly?
Using NSAIDs can decrease the effectiveness of which other drugs?
If NSAIDs do have to be used, what is a better option?
What medication is equally as effective as NSAIDs in mild osteoarthritis and should be used instead?
Increased risk of GI bleed
Decline in GFR
Diuretics and anti-hypertensives
Selective COX2 inhibitors
Paracetamol
What are the main reasons for being strict when it comes to antibiotic prescribing in the elderly?
Resistance
C. Diff risk
Which drugs should not be used for treatment of diarrhoea of unknown cause in the elderly, as they can exacerbate the condition and result in constipation with overflow diarrhoea?
What are some other reasons why these should not be used?
Loperamine or codeine phosphate
Can precipitate toxic megacolon in IBD
May delay recovery in unrecognised gastroenteritis
Metaclopramide and prochlorperazine should be avoided in patients with which condition and why?
Parkinson’s
Can exacerbate symptoms
Why should laxatives not be used in intestinal obstruction?
Risk of bowel perforation
A beta blocker should not be prescribed alongside verapamil for what reason?
Non-cardioselective beta blockers should not be used in patients with what condition and why?
In patients with chronic constipation, which CV drug should be avoided?
Increases risk of symptomatic heart block
COPD/asthma - risk of bronchospasm
Ca++ blockers
Dipyridamole should no longer be used for what?
What is the exception to this?
Monotherapy for CV secondary prevention
If the patient is intolerant to aspirin or clopidogrel
When should PPIs be prescribed?
For severe GORD
Patients aged 80+ on anti-platelets or SSRIs
If aspirin and warfarin are being used in combination (unlikely)
When should fibre supplements be prescribed?
For diverticular disease which is symptomatic with constipation
When should elderly people be given an antihypertensive?
When should elderly people be given an ACE inhibitor?
When should elderly people be given warfarin or a DOAC?
If systolic BP > 160
If they have heart failure or post-MI
In chronic AF or following a DVT/PE if benefit > risk
Codeine and tamsulosin are both drugs which are known for causing what adverse effect in the elderly?
Which drug is particularly well known for precipitating/prolonging delirium?
An alpha blocker (e.g. tamsulosin for prostatism) and an anti-hypertensive in combination often shows what adverse effect?
A combination of trimethoprim and an ACE inhibitor is most likely to cause what adverse affect?
Cognitive decline
Benzodiazepines
Postural hypotension
Decline in renal function
What is the risk of drugs causing problems with cognition and consciousness in the elderly?
What problem with regards to bowel function are elderly people more likely to suffer from as a medication side effect?
What are some drug side effects which affect dizziness and balance? What is the risk of these?
Increased risk of delirium
Constipation
Parkinsonism and postural hypotension, increases risk of immobility and falls
If a patient has a bleeding ulcer, what drug should be stopped?
If a patient has kidney failure, what drug should be stopped?
If a patient has hyponatraemia, what drug should be stopped?
NSAID
ACE inhibitor
Anti-depressant
Why should gabapentin not be used in the elderly?
When should you stop using primary prevention in elderly people?
Dizziness, fatigue, visual disturbance - confusion
If they have a short life expectancy
Describe the concept of anti-cholinergic burden?
The more of these drugs that patients are on, the more side effects they will get (summative effect)
