Prescribing In Elderly Care

Question 1

What criteria is in place to reduce drug related ADRs and poly pharmacy?

Answer 1

STOPP (screening tool of older persons potentially inappropriate prescriptions)

Question 2

What criteria is in place to prevent omissions of indicated, appropriate medicines in older patients with specific conditions?

Answer 2

START (screening tool to alert to right treatment)

Question 3

What could swallow difficulties in the elderly lead to and what advice could you give to avoid it?

Answer 3

Oesophageal ulceration
Encourage to take with plenty of water and to remain upright
Or switch to liquid if available

Question 4

What 6 drugs are the elderly typically sensitive to?

Answer 4

Opioids, benzodiazepines, antipsychotics, antiparkinsonian, antihypertensives, NSAIDs

Question 5

What happens to renal function?
What effect does this have on drugs?

Answer 5

Renal clearance is reduced
Drugs excreted more slowly, drug accumulation more likely, patients highly susceptible to nephrotoxic drugs

Question 6

In addition to increasing age, what else can affect renal function?

Answer 6

Acute illness - especially if accompanied by dehydration
Reduced volume, reduces glomerular hydrostatic pressure = reduced glomerular filtration rate = reducing renal clearance

Question 7

Digoxin is a narrow TI drug, what could happen if the patients renal function declines?

Answer 7

Lead to accumulation of drug as not being cleared quickly enough = digoxin toxicity

Question 8

Why is hepatic metabolism of lipid soluble drugs reduced?

Answer 8

Due to reduced liver volume

Question 9

What hypnotics should be used in the elderly and why?

Answer 9

Ones with short half-lives
Long half life hypnotics have serious hangover effects including drowsiness, unsteady gait, slurred speech, and confusion (zolpiderm, zopiclone are short)

Question 10

Are diuretics first line in gravitational oedema?

Answer 10

No
Should advise to increase movement, raise the legs and support stockings
Diuretics can speed up treatment but should NOT be used long term

Question 11

Due to increased susceptibility of the elderly to NSAIDs, what recommendation is made for osteoarthritis, soft tissue lesions, and back pain?
And pain in RA?

Answer 11

Weight reduction if obese, warmth, exercise, and use of walking stick
Pain in RA = paracetamol