Principles of drug use in older people

Question 1

What is an adverse drug reaction?

Answer 1

An undesirable effect of a drug beyond its anticipated therapeutic effects occurring during clinical use.
3x more likely to occur in the elderly

Question 2

What is the DoTS classification for adverse drug reactions?

Answer 2

Adverse drug reactions related to:
Dose
Time-course
Susceptibility

Question 3

What is a toxic reaction?

Answer 3

When dose is above therapeutic range

Example: bleeding following too high dose of warfarin

Question 4

How would you treat/prevent a toxic adverse drug reaction?

Answer 4

Reduce dose

Prevent by using minimal effective dose

Question 5

What is a collateral reaction?

Answer 5

Adverse drug reaction within the therapeutic range
Example: drowsiness due to antihistamine use
[May be unavoidable]

Question 6

What is a hypersusceptibility reaction?

Answer 6

When dose is below therapeutic range

Example: penicillin allergy

Question 7

What are the various time-course related ADRs?

Answer 7

First dose reactions 
Early reactions 
Intermediate reactions 
Late reactions 
Withdrawal reactions 
Delayed reactions

Question 8

What can be done to avoid first dose reactions?

Answer 8

Advice

Special precautions

Question 9

What is done in response to early reactions?

Answer 9

Patient becomes tolerant to reactions - generally fine to continue treatment as ADR should wear off