Ageing deck 2

Question 1

What is reablement?

Answer 1

Individual regaining skills, confidence and independence to enable them to do things for themselves

Question 2

What are the principles of rehabilitation and reablement?

Answer 2

Person centred
Goal directed
Co-ordinated
Improved outcomes

Question 3

What are pharmacokinetics?

Answer 3

Absorption
Distribution
Metabolism
Excretion

Question 4

What are pharmacodynamics?

Answer 4

Drug action on the body

Question 5

If a drug is excreted by the kidney, what should you consider?

Answer 5

Dose deduction

Question 6

If a person has cachexia or a low weight, what should you consider doing?

Answer 6

Changing the dose (lowering it)

Question 7

What type of environment do acidic drugs require in order to be absorbed?

Answer 7

Acidic environment

Question 8

What type of environment do basic drugs require in order to be absorbed?

Answer 8

Basic environment

Question 9

Name some acidic drugs (3)

Answer 9

Phenytoin
Aspirin
Penicillins

Question 10

Name some basic drugs (3)

Answer 10

Diazepam
Morphine
Pethidine

Question 11

Why should you consider drug delivery in elderly patients?

Answer 11

Dysphagic or confused patients will not be able to swallow tablets etc

Question 12

What protein binds to acidic drugs?

Answer 12

Albumin

Question 13

Is albumin acidic or basic?

Answer 13

Basic

Question 14

If you administer penicillin to a patient with low albumin, why would the drug not be absorbed well?

Answer 14

Penicillin (acidic) binds to albumin however there is not a lot of albumin so not a lot of penicillin can be absorbed

Question 15

What protein binds to basic drugs?

Answer 15

Alpha-1 acid glycoprotein

Question 16

Is Alpha-1 acidic glycoprotein basic or acidic?

Answer 16

Acidic

Question 17

Do elderly patients tend to have:

High/low albumin
High/low A-1 AG?

Answer 17

Low albumin

High A-1 AG

Question 18

Why do the elderly have increased lipid binding?

Answer 18

Increased fat to muscle ratio

Question 19

Why should you perhaps lower the doses of lipophilic drugs when giving them to the elderly?

Answer 19

Increased proportion of fat means increased VD of lipophilic drugs and a longer half life

Question 20

What is the volume of distribution?

Answer 20

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

Question 21

Why are lipophilic drugs particularly dangerous in the elderly?

Answer 21

Sit in fatty tissue for a long time.

Any period of cachexia and then the drug will be released as fat breaks down

Question 22

What type of drug has a low volume of distribution in the elderly and why?

Answer 22

Hydrophilic drug

Decreased body water

Question 23

What is the biological half life of a drug?

Answer 23

Time it takes for a drug to get down to half of its biological/pharmacological activity

Question 24

Why do elderly people have a reduced liver function?

Answer 24

Decreased liver size and blood flow and disease

First pass metabolism reduced

Question 25

Why do elderly people have a slower renal metabolism?

Answer 25

Lower GFR due to decreased: - size - tubular secretion - renal blood flow

Question 26

Lower doses achieve the same affect in the elderly. True or false?

Answer 26

True

Question 27

What are some drugs with a narrow therapeutic index e.g. <2?

Answer 27

``` Theophylline Warfarin Lithium Digoxin Gentamicin Vancomycin Phenytoin Cyclosporin Carbamazepine Levothyroxine ```

Question 28

What drugs are most frequently associated with adverse reactions in the elderly?

Answer 28

``` Warfarin Digoxin Insulin Benzodiazepines Diuretics NSAIDs Corticosteroids Anti-hypertensive agents Opioids Theophylline ```

Question 29

If you are going to prescribe an opioid to an elderly patient, what should you prescribe in addition to this?

Answer 29

Lactulose or senna (laxitives)

Question 30

What do you need to consider when prescribing steroids in the elderly?

Answer 30

Osteoporosis prevention if long term. Steroid induced diabetes.

Question 31

What interferes with absorption of levothyroxine?

Answer 31

Calcium

Question 32

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

Answer 32

Paracetamol

Question 33

What are the risks of taking NSAIDs, especially in the elderly?

Answer 33

GI haemorrhage Decline in GFR Decreased effectiveness of diuretics and anti-hypertensives

Question 34

If you really have to give an elderly patient an NSAID, what should you prescribe them?

Answer 34

Ibuprofen or naproxen

Question 35

What are the adverse effects of taking opioids and benzodiazepines?

Answer 35

Impairs psychomotor function Falls and confusion

Question 36

What GI drugs should you stop in the elderly?

Answer 36

Loperamide or codeine phosphate Prochlorperazine or metoclopramide Stimulant laxitives

Question 37

What GI drugs should you start in the elderly?

Answer 37

PPI | Fibre supplement

Question 38

What CV drugs should you stop in the elderly?

Answer 38

Beta-blocker Non-cardioselective beta-blocker Calcium channel blockers Dipyridamole Statins

Question 39

Why should you stop beta-blockers in the elderly?

Answer 39

Risk of symptomatic heart block

Question 40

Why should you stop non-selective beta-blockers in patients with COPD?

Answer 40

Risk of bronchospasm

Question 41

What CV drugs should you consider starting in the elderly?

Answer 41

Antihypertensive ACEi PPI Warfarin/DOACs