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Flashcards in 9 Elderly - HH Deck (17):
1

Why is prescribing in older people difficult (4)

Multiple pathology
Polypharmacy
Difficulties with adherence
Altered drug handling (physically and PK/PD)

2

Problem with multiple pathology (2)

interaction between disease states and medicines
lack of appropriate trial data

3

Unintentional non-adherance issues (5)

Physical difficulty with pack/device
poor swallow
confusion/memory problems
lack of info/poor communication
complicated regieme

4

intentional adherence issues 5

deliberate adjustments
lack of confidence in med/Rxer
S/e (and concerns about these)
lack of info/poor communication
complicated regieme

5

Improving adherance ideas 4

assess use of meds - poping out/inhalers/eye drops
large print labels
plain top bottles
med reminder card

dosset box!

6

What is the issues with MCA (multicomparment compliance aids)

(4)

need to understand how to use it
take away independence/understanding
many filled to allow carer to prompt

Off label
Stability issues

7

What to assess before offering compliance aid

knowledge
visual
manual dexterity
cognition
supply

8

Where can you look up if a drug is stable in a compliance aid

medicines compliance aid database

9

Where can you look up if a drug is stable in a compliance aid

medicines compliance aid database

10

Changes in absorption:

2 exceptions

reduced by all routes but extent unchanged

Reduced absorption of vit
increased absorption of levodopa

11

Changes in distribution

Slower distribution.

Reduced water so increased conc of water soluble drugs (dig/gent/theophylline/Li)

Increased fat - prolonged effects of fat soluble (diazepam/phenytoin)

Reduced albumin - increase protein bound drug conc (NSAIDs/furosemide)

Reduced muscle (increased digoxin)

12

Changes in metabolism

largely there is reserve so ? significance

reduced hepatic perfusion
reduced 1st pass
reduced hepatic enzymes

13

Changes in elimination

predictable agerelated decrease in renal func

14

Renal func problems in eledery worsened by

diabetes
infection
cardiac failure
dehydration

15

Pharmacodynamic changes

"What the drug does to the body"
changes in target organ responsiveness
loss of homeostatic mechanism
changes in target receptor sensitivity
(increased effect of CNS acting drugs, decreased efficacy of beta blockers)

16

Principles of safe prescribing 4

start low/go slow
simple regiemes
watch for s/e and interactions and efficacy
set clear theraputic goals

17

7 examples from the STOPP /START tools of inappriopraite prescribing with comorbidities
1. Dig in ...
2. Neuroleptics...
3. Metoclopramide....
4. NSAIDs....
5. Warfarin....
6. ACEi .....
7. Bisphophinates...

1. Long term digoxin > 125mcg with impaired renal function
2. Neuroleptics as long term hypnotics
3. Metoclopramide in Parkinson's disease
4. NSAID in heart failure
5. Warfarin in chronic AF
6. ACE-I in chronic heart failure
7. Bisphosphonates in patients on maintenance corticosteroids