Prescribing In Elderly

Question 1

Elderly

Answer 1

65 +

Question 2

Risks in elderly

Answer 2

Poly pharmacy - multiple drug for multiple diseases; increases interactions, s/e and non-compliance
Reduced renal clearance - excrete drugs slowly, highly susceptible to nephrotoxic drug
Acute illness = can lead to rapid decrease or decline causing AKI
Reduced hepatic metabolism - of lipid-soluble drugs due to decrease in liver volume
Increases sensitivity of nervous system - prone to s/e e.g drowsiness in benzo or opioids etc
More susceptible to s/e - common confusion, constipation etc

Question 3

Diuretics in elderly

Answer 3

Postural hypotension = falls
Simple gravitational oedema
Avoid long term use - dehydration and electrolyte imbalances

Question 4

Hypnotics in elderly

Answer 4

Short acting is better to avoid hangover effects - which can imapair balance and cause falls

Question 5

NSAIDs in elderly

Answer 5

Bleeding risk increased
Hazard with cardiac disease or renal impairment patients

Question 6

osteoarthritis pain

Answer 6

Try weight reduction, warmth, exercise first
If osteoarthritis; soft tissue lesions, back pain and pain in RA; paracetamol or low dose NSAID
Not to take 2 NSAIDs at the same time and prophylaxis is needed e.g PPI
If the pain relief is not adequate add paracetamol + NSAID if necessary increase NSAID or add opioid