Prescribing in the Elderly

Question 1

Acidic drugs require an acidic environment for absorption

Answer 1

Basic drugs require a basic environment for absorption

just info

Question 2

Name an acidic drug

Answer 2

Phenytoin
Aspirin
Penicillins

Question 3

Name a basic drug

Answer 3

Diazepam
Morphine
Pethidine

Question 4

What binds to acidic drugs?

Answer 4

Albumin (basic)

Question 5

What binds to basic drugs?

Answer 5

Alpha-1 acid glycoprotein (acidic)

A-1 AG

Question 6

Do the elderly have:

High/low Albumin
High/low A1-AG?

Answer 6

Low albumin

High A-1 AG

Question 7

Why do lipophylilc drugs have a longer half life in the elderly?

Answer 7

Elderly have a higher fat to muscle mass ratio

Question 8

Why do hydrophilic drugs have a lower distribution in the elderly?

Answer 8

Elderly have decreased body water

Question 9

Name a lipophylic drug

Answer 9

Diazepam

Anaesthetics

Question 10

Name a hydrophilic drug

Answer 10

Lithium

Digoxin

Question 11

Where does first pass metabolism occur?

Answer 11

Gut + LIVER

Question 12

Why is first pass metabolism reduced in the elderly?

Answer 12

Decreased liver size, blood flow and possible liver disease

Question 13

What does first pass metabolism do?

Answer 13

Greatly reduces drug concentration before it enters circulation

Question 14

Generally, lower doses achieve the same effect in the elderly but some drug’s effects are decreased. What drugs might these be?

Answer 14

Beta blockers + HR

Question 15

Name some drugs with narrow therapeutic index

Answer 15

Warfarin
Lithium
Digoxin
Theophyllin
Gentamicin
Vancomycin
Phenytoin
Cyclosporin
Carbamazepine
Levothyroxine

Question 16

What is the volume of distribution?

Answer 16

Theoretical volume if all of the drug you give to a patient was completely absorbed and distributed within the plasma

Question 17

Why are lipophilic drugs dangerous?

Answer 17

Sit in fatty tissue for a long time

any period of cachexia then the drug will be released as it breaks down

Question 18

What should you give to a an elderly patient in conjunction with opioids?

Answer 18

lactulose or senna

Question 19

If a patient is gonna be on steroids long term, what should you give them in addition?

Answer 19

Osteoporosis prevention

be aware of steroid induced diabetes

Question 20

What interferes with absorption of levothyroxine?

Answer 20

Calcium

Question 21

What drug is just as effective as NSAIDs in mild OA?

Answer 21

Paracetamol

Question 22

Why are opioids and benzos avoided in the elderly?

Answer 22

Impair psychomotor function

Falls and confusion

Question 23

Why should you avoid giving lots of antibiotics in the elderly?

Answer 23

Resistance and C.diff

Question 24

What is BEERs criteria?

Answer 24

Notifies drugs that are potentially inappropriate to give to the elderly

Question 25

Why should you stop prescribing loperamide or codeine phosphate in the elderly?

Answer 25

For treatment of diarrhoea - delays diagnosis
May exacerbate constipation
May precipitate toxic megacolon and IBD

Question 26

Why should you avoid prescribing metoclopramide and prochlorperazine in Parkinson’s?

Answer 26

May exacerbate it

Question 27

Why should you not prescribe stimulant laxatives in patients with intestinal obstruction (Senna)?

Answer 27

Risk of bowel perforation

Question 28

Why should you stop beta blockers in combination with verapamil?

Answer 28

Risk of symptomatic heart block

Question 29

Why should you not prescribe a non-cardioselective beta blocker in patients with COPD?

Answer 29

Risk of bronchospasm

Question 30

What drug should you start in chronic heart failure/post MI?

Answer 30

ACEi

Question 31

What drug should you start in chronic AF?

Answer 31

Warfarin