Prescribing in the elderly

Question 1

what aspects differ in elderly patients?

Answer 1

altered physiology 
altered pharmacokinetics
altered pharmacodynamics
multipathology 
diminished cognitive function 
general frailty
impaired homeostatic mechanisms
polyprescribing
polypharmacy 
drug interactions 
adverse effects 
different indications, attitudes and needs

Question 2

stepwise pharm management of HT

Answer 2

1) inhibitors of RAAS system- ACEi, Ang II rec antag, renin inhibtors
2) beta blockers
3) CCBs
4) diuretics
5) other vasodilator drugs

Question 3

name 5 drugs that the elderly have increased sensitivity to

Answer 3

benzos
opiates
anti-hypertensives 
warfarin
long acting hypoglycaemic agents 
drugs acting on the CNS

Question 4

describe the 5 stages of what happens to a drug in the body

Answer 4

1) liberation
2) absorption
3) storage and deposition
4) target site and effects
5) metabolism
6) excretion

Question 5

5 main changes in the elderly that may alter drug pharmacokinetics

Answer 5

Decreased renal function

Reduced liver size & function
(decreased lean mass & blood flow)

Reduced plasma proteins

Changes in body composition
(increased fat; decreased lean mass/body water)
GI changes
(higher gastric pH; slower gastric emptying; splanchnic blood flow)

Question 6

what are the 2 phases of hepatic metabolism

Answer 6

oxidation

conjugation

Question 7

5 examples of common hepatically metabolised drugs

Answer 7

propanolol
labetalol
metoprolol
nitrates
metoclopramide
opioids
anti-psychiotics
SSRIs

Question 8

5 examples of renally excreted drugs

Answer 8

gentamicin
digoxin
lithium
beta blockers
ACEi
metformin

Question 9

name 5 drugs that should be used with caution in the elderly

Answer 9

long term NSAIDs
benzos
tricyclics
amiodarone
warfarin
SSRIs