Prescribing In Older Adults Flashcards
Pharmacodynamics
Changes in sensitivity to drug action
How the drug interacts with the body to produce a response
Eg G protein cascade
Decreased enzymes as we age make the process less effective
Pharmacokinetics
Wha the body does the to the drug Absorption Distribution Metabolism Excretion
Pharmacokinetic changes in ageing
Increased body fat-> increase distribution of fat soluble drugs
Decreased total body water-> decreased distribution of water soluble drugs
Decreased serum albumin-> increased effect of drugs that bind albumin
Reduced liver volume and enzyme activity-> decreased hepatic metabolism
Reduced GFR-> reduced renal excretion, digoxin
Reduced blood flow to organs
Use the Cockcroft golt equation for GFR, age and weight
Consequences of inappropriate prescribing
Increased length of stay Increased morbidity and mortality 10-12% of all hospital admissions Poor compliance Increased risk of adverse drug reactions
STOPP criteria
Screening Tool of Older Persons Prescriptions
Criteria for inappropriate drugs
Lists of poor drug choices and the reason behind it
Indicates drugs doctors should consider stopping
START criteria
Screening Tool to Alert for Right Treatment
Aid in deciding the correct medication
List of medications and there indication
National service framework
Recommendations to ensure:
Gain maximum benefit to maintain/ improve
Do not suffer unnecessarily from ADRS
Risk factors
Impaired cognition Four or more co morbidities Dependent living situations Impaired renal function Non adherence to medication regimen Poor mental health Lack of home support Sensory deficits Poly pharmacy
Drugs with increased sensitivity
Benzodiazepines
Ain’t hypertensives
Tricyclics
Warfarin
Drugs with decreased sensitivity
Beta agonists
Beta blockers
High risk medications
NSAIDs Warfarin Diuretics Hypnotics Anti hypertensives Antidepressants Antipsychotics Digoxin Opiates Vancomycin and gentamicin
Risk factors for NSAID complications
>65 Previous history of gi bleed/ulcer Concurrent medications Serious comorbidities Type of NSAID Prolonged use Excessive alcochol Heavy smoking H.pylori
Adverse effects of PPI’s
Associated with: Hip fracture CAP HAP C.difficile Electrolytes abnormalities
Definition of inappropriate prescribing
Contraindicated drugs
Wrong dose or duration
Adversely affect prognosis
Failure to use appropriate drug
