Prescribing in the elderly

Question 1

Why can b-blockers cause heart block in the elderly?

Answer 1

Less renal excretion
Increased levels

Dose should be 25mg atenolol

Question 2

Which drugs are effected by reduce liver function?

Answer 2

Labetalol
Morphine
Nifedipine
Propranolol

Question 3

Which drugs are a problem in reduce renal function?

Answer 3

Digoxin
Gentamicin 
NSAIDs
Lithium
Metformin
Thiazides diuretics

Question 4

How to work out creatinine clearance in older adults wi reduce muscle mass?

Answer 4

Cockcroft - gault formula

Question 5

Digoxin toxicity how do you manage the digoxin?

Answer 5

Stop digoxin
Measure levels
1/4 dose (250 would go to 62.5)

Question 6

What basic measurement should always be taken when prescribing in the elderly?

Answer 6

Weight

Often thin, normal adult dose not appropriate eg paracetamol

Question 7

Side effects of amlodipine (calcium channel blockers)

Answer 7

Peripheral oedema

Dizziness

Question 8

Side effects of ace-I

Answer 8

Cough (will not improve straight away)

Hypotension

Question 9

Side effects of iron (ferrous sulphate)

Answer 9

Constipation

Black stools

Question 10

Side effect of metformin

Answer 10

Nausea, bloating, diarrhoea

Start low and go slow
Warn patients

Question 11

Meds that increase flare of gout?

Answer 11

Diuretics : thiazides (chlortalidone), furosemide

Question 12

Avoid in close-angle glaucoma

Answer 12

Tricyclics antidepressants ( due to anti-chlonergic depressants)

Question 13

Restarting digoxin in uncontrolled af?

Answer 13

Loading dose Iv 250g

Then normal 125mg oral dose daily