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Flashcards in 9 Elderly Deck (20):
1

Questions to ask looking at elderly drugs 6

Is there and indication? Are their untreated indications? Therapy appropriate for the indication?

Interactions or contraindications?

Therapeutic monitoring up to date?
Is there evidence of efficacy? Evidence that clinical review has taken place and therapy is still required?

Dosing schedule/formulation appropriate?

Does the patient understand/comply?

Side Effects reported by patient and recorded?

2

Classes of medication associated with falls

NSAIDS
Opioids
Other sedatives and hypnotics (antihistamines and sleeping)
Diuretics

Antipsychotics
Beta block
Antidepressants
BZs
Anti hypertensives

3

Why don't we use phenothiazines for dizziness due to postural hypotension

Themselves cause postural hypertension

4

Neuroleptics for confusional state?

Cause confusion and low BP

5

Levodopa for non parkinsons tremor

Not cause by low da

6

BZ for insomnia from depression

Treat the depression
Worsens cognition

7

Loop diuretics for dependant oedema

Ineffective.
Compression stockings

8

BZ ever.,

No - risk of cognitive impairment and falls

9

Long acting oral hypoglycemics

No hypos in elderly particularly hard to notice and renal function could prolong effet

10

ACh for Parkinson's disease

Increased cognition problems and antimuscurinic sideeffects

11

Muscle relaxants for spasticity

Not specific to those muscles so they increase risk of falls

12

Amitryptiline for neuropathic pain?

No - antichlinegic. Change to GABA or pregab

13

Cause weight in paracetamol

Below 50kg

14

Old people pain relief steps

Paracetamol then co-codamol then morhpine.
Don't use NSAIDS due to cv risk and bleeding

15

In all patients in the case situ does consider

Oestoperosis
Constipation
VTE

Cv risk
Diabetes control

16

Treatment for oestoperosis

Calcium
Vit d
Bisphosphate

17

Selecting and agent for depression in elderly?

SSRI but caution hyponatremia
Or consider new ones or snri

18

Alternative to oxybutaitn

Finasterilde or tamsulosin

19

Base line tests in mental health

U and e
Lft
FBC
Thyroid
BG
Lipid profile
Prolactin
Bmi
BP
Pulse
Ecg ( prior to start of antipsychotics

20

Medication related problem risk factors

4 or more meds
Specific meds like warfarin, NSAIDS, diuretics and digoxin
Recent discharge from Hosptial
Low level of home support
Physical. (Eyesight, manual dexterity)
Mental state