Prescribing for older patients

Question 1

older persons in clinical trials

Answer 1

often excluded from clinical trials
leads to lack of evidence and good quality guidlines

Question 2

changes that occur in raging that effect pharmacokinetics and pharmacodynamics

Answer 2

volume of distribution: which influences loading doses
clearance: which influences maintenance doses

changes are more pronounced with frailty

Question 3

implications of frailty

Answer 3

increased body fat
decreased lean body mass
age related reduction in albumin

Question 4

consequence of reduction in albumin

Answer 4

total drug levels of albumin bound drugs can be unreliable e.g. valproate, phenytoin
can be toxic at apparently therapeutic levels

Question 5

sarcopenia

Answer 5

age related loss of skeletal muscle mass and strength

Question 6

ADME stands for

Answer 6

absorption
distribution
metabolism
excretion

Question 7

changes in absorption

Answer 7

slowed gastric motility and reduced hepatic metabolism
delayed absorption and reduced bioavailability of drugs administered orally

Question 8

changes in distribution

Answer 8

sarcopenia and relative adiposity
reduced plasma albumin
reduced volume of distribution of water soluble drugs and increased volume of distribution of fat soluble drugs

Question 9

changes in metabolism

Answer 9

reduced hepatic volume and blood flow
reduced phase 2 clearance

Question 10

changes in excretion

Answer 10

glomerular filtration rate reduced
reduced renal drug clearaance

Question 11

changes in pharmacodynamcs

Answer 11

reduced resilience to external stressors
may be some reduced receptor function in presence of chronic inflammation
exaggerated or reduced drug effects

Question 12

4 main classes of medications causing ADR in older patients

Answer 12

warrfarin
insulin
oral antiplatelet agents
oral hypoglycaemic agents

Question 13

‘prescribing cascade’

Answer 13

occurs when a new medication is prescribed to treat symptoms that have arisen from an unrecognised adverse drug effect that is the result of an existing therapy

Question 14

prescribing omissions

Answer 14

also known as under prescribing
failure to prescribe a medication for which there is a clinical indication and which, for the patient, is appropriate to prescribe

Question 15

potentially inappropriate medications

Answer 15

PIMS
medications where risk of adverse events from the drug outweighs the clinical benefit

Question 16

prescribing tools

Answer 16

STOPP
START
Drug Burden Index
Beers Criteria
Inappropriate Medication Use and Prescribing Indicators Tool

Question 17

deprescribing

Answer 17

the process of withdrawal of an inappropriate medication, supervised bu a healthcare professional with the goal of improving outcomes

Question 18

deprescribing

Answer 18

the process of withdrawal of an inappropriate medication, supervised bu a healthcare professional with the goal of improving outcomes

Question 19

principles of deprescribing

Answer 19

monitoring outcomes (withdrawal and rebound symptoms, original symptom recurrence, symptom improvements)
stop one drug at a time and wean over weeks

Question 20

benefits of deprescribing

Answer 20

resolve related adverse drug effects
improve patient satisfaction and QOL
improve physical and cognitive function
reduce financial cost to patient and community