Prescribing in older People Flashcards
What is defined as an older patient?
Over 65
What is a better indicator of an older patient?
Frailty
What is polypharmacy?
5 medications or more
What is (hyper)polypharmacy?
10 or more medications
What are the benefits of guidelines?
Evidence based + standardised patient care
What are the cons of guidelines?
Don’t consider the guidelines of other medications
Describe the prescribing cascade
Drug 1
Adverse effects
Drug 2 to treat side effects
Adverse effect
Drug3 to treat side effects
What can ibuprofen cause?
Fluid retention = hypertension
What treats hypertension?
Amlodipine
= cause oedema
What treats oedema?
Furosemide
= diuretic = dizzy
What treats dizziness?
Betahistine hydrochloride
= constipation
What treats constipation?
Movicol = laxative
What changes with age?
Absorption
Distribution
Metabolism
Excretion
Tissue sensitivity
What is tissue sensitivity?
How drug interacts with tissues
What is the risk of NSAIDs as age increases?
Risk of bleed increases
= delayed gastric emptying
= medicines spend longer in GI tract
What is the solution with older patients taking NSAIDs?
PPIs - eg. Omeprazole
Describe protein binding
Drugs bind to albumin
When bound = doesn’t work = biological effect comes from unbound drug
What happens with protein binding in older patients?
Less albumin when older
= less drug bound
= increased free drug
What are examples of protein bound drug?
NSAIDs
Warfarin
Aspirin
How do you choose an NSAID for an older patient?
Pick right NSAID for condition
Start at low dose
THEN maybe add new PPI
How does hepatic function change with age?
As you get older liver decreases in size + blood flow decreases
1st pass = drugs massively metabolised before works
What happens with renal function with age?
Decreases with age
What is the Beers Criteria?
Big list of medication explaining whether you should use it in older people
What is the other criteria for older patients?
START/STOP Criteria
How long does it take for a statin to work?
Number of years to have benefit
