Prescribing in the Elderly

Question 1

Name the 4 stages of a drug in the body

Answer 1

Absorption
Distribution
Metabolism
Excretion

Question 2

What kind of environment do acidic drugs need for absorption?

Answer 2

Acidic

Question 3

What kind of environment do basic drugs need for absorption?

Answer 3

Basic

Question 4

Aspirin and penicillin are acidic?

Answer 4

True

Question 5

Diazepam and morphine are basic?

Answer 5

True

Question 6

Describe the pH of an elderly persons gastric environment.

Answer 6

More basic (increased pH)

Question 7

Increased gastric pH means?

Answer 7

Less acidic

Decreased small bowel surface area

Question 8

In what situations would the increasing gastric pH with age be a problem?

Answer 8

GI surgery
NG or PEG
Transdermal patches and oedema
More basic drugs are absorbed

Question 9

Name the 2 main binding proteins in the human body.

Answer 9

Albumin

Alpha -1 acid glycoprotein

Question 10

Elderly people have high albumin and low a-1-a glycoprotein

Answer 10

FALSE

other way around

Question 11

What condition causes elderly people to have less muscle and more fat?

Answer 11

Sarcopenia

Question 12

What does more fat mean?

Answer 12

More lipid binding

Question 13

What kind of drugs bind to lipids?

Answer 13

Lipophilic drugs

Question 14

Name some lipophilic drugs.

Answer 14

Diazepam

Anaesthetics

Question 15

Is the Vd of lipophilic drugs big or small?

Answer 15

BIG

Question 16

Lipophilic drugs have a long half life?

Answer 16

True

Question 17

Why do older patients tend to have longer half lives?

Answer 17

Their renal and liver function isn’t as good so clearance is slower

Question 18

Why is liver function not as good in the elderly?

Answer 18

Decreased liver size
Decreased blood flow
Diseases

Question 19

Why does renal metabolism worse with age?

Answer 19

Lower GFR
Decreased size of kidneys
Decreased tubular secretion
Decreased renal blood flow

Question 20

LOWER DOESES ACHIEVE THE SAME EFFECT IN THE ELDERLY

Answer 20

True e.g alcohol

Question 21

Name some drugs with a narrow therapeutic index.

Answer 21

Warfarin
Lithium
Digoxin
Gentamicin
Vancomycin
Levothyroxine

Question 22

Therapeutic window and toxin response decreased with?

Answer 22

Age

Question 23

What are the 4 drugs most frequently associated with adverse reactions in the elderly?

Answer 23

1. Warfarin
2. Digoxin
3. Insulin
4. Benzodiazepines

Question 24

What are the main side effects of steroids?

Answer 24

Osteoporosis

Steroid induced diabetes

Question 25

What interferes with the absorption of thyroxine/levothyroxine?

Answer 25

Calcium

Question 26

List the side effects of NSAIDs

Answer 26

GI haemorrhage
Decline in GFR
Decreased effectiveness of diuretics and anti-hypertensives

Question 27

When should you use a PPI?

Answer 27

GORD

Peptic stricture needing dilation

Question 28

When is a fibre supplement given?

Answer 28

For chronic, symptomatic, diverticular disease with constipation

Question 29

What should you not give in intestinal obstruction?

Answer 29

Stimulating laxatives

Question 30

What should you not give to patients with Parkinson’s?

Answer 30

Metoclopramide

Prochlorperazine

Question 31

When should loperamide be stopped?

Answer 31

Diarrhoea
Constipation with overflow diarrhoea
Toxic megacolon in IBD
Gastroenteritis

Question 32

When should codeine be stopped?

Answer 32

Diarrhoea
Constipation with overflow diarrhoea
Toxic megacolon in IBD
Gastroenteritis

Question 33

What should you never give a beta blocker with?

Answer 33

Verapamil

Question 34

You should stop 80mg statin after … months post MI?

Answer 34

6

Question 35

What should patients with COPD not be given?

Answer 35

A non cardioselective beta blocker e.g propanolol

Question 36

Who should not get calcium channel blockers?

Answer 36

Those with chronic constipation

Question 37

When should an ACEI be given?

Answer 37

Chronic heart failure or post MI

Question 38

What is given in AF, DVT and PE?

Answer 38

Warfarin