Prescribing in older People

Question 1

What is defined as an older patient?

Answer 1

Over 65

Question 2

What is a better indicator of an older patient?

Answer 2

Frailty

Question 3

What is polypharmacy?

Answer 3

5 medications or more

Question 4

What is (hyper)polypharmacy?

Answer 4

10 or more medications

Question 5

What are the benefits of guidelines?

Answer 5

Evidence based + standardised patient care

Question 6

What are the cons of guidelines?

Answer 6

Don’t consider the guidelines of other medications

Question 7

Describe the prescribing cascade

Answer 7

Drug 1
Adverse effects
Drug 2 to treat side effects
Adverse effect
Drug3 to treat side effects

Question 8

What can ibuprofen cause?

Answer 8

Fluid retention = hypertension

Question 9

What treats hypertension?

Answer 9

Amlodipine
= cause oedema

Question 10

What treats oedema?

Answer 10

Furosemide
= diuretic = dizzy

Question 11

What treats dizziness?

Answer 11

Betahistine hydrochloride
= constipation

Question 12

What treats constipation?

Answer 12

Movicol = laxative

Question 13

What changes with age?

Answer 13

Absorption
Distribution
Metabolism
Excretion
Tissue sensitivity

Question 14

What is tissue sensitivity?

Answer 14

How drug interacts with tissues

Question 15

What is the risk of NSAIDs as age increases?

Answer 15

Risk of bleed increases
= delayed gastric emptying
= medicines spend longer in GI tract

Question 16

What is the solution with older patients taking NSAIDs?

Answer 16

PPIs - eg. Omeprazole

Question 17

Describe protein binding

Answer 17

Drugs bind to albumin
When bound = doesn’t work = biological effect comes from unbound drug

Question 18

What happens with protein binding in older patients?

Answer 18

Less albumin when older
= less drug bound
= increased free drug

Question 19

What are examples of protein bound drug?

Answer 19

NSAIDs
Warfarin
Aspirin

Question 20

How do you choose an NSAID for an older patient?

Answer 20

Pick right NSAID for condition
Start at low dose
THEN maybe add new PPI

Question 21

How does hepatic function change with age?

Answer 21

As you get older liver decreases in size + blood flow decreases
1st pass = drugs massively metabolised before works

Question 22

What happens with renal function with age?

Answer 22

Decreases with age

Question 23

What is the Beers Criteria?

Answer 23

Big list of medication explaining whether you should use it in older people

Question 24

What is the other criteria for older patients?

Answer 24

START/STOP Criteria

Question 25

How long does it take for a statin to work?

Answer 25

Number of years to have benefit