Care Of The Elderly

Question 1

How is distribution, metabolism and excretion affected with aging

Answer 1

Distribution
• increase in body mass/weight - higher volume of distribution for lipophilic drugs
• decrease in total body water - less distribution for hydrophilic drugs

Metabolism
• shrinkage of liver and reduced body flow = decrease in drug metabolism

Excretion
• decrease in CrCl
• poor function of glomerular and tubules
^ effects drug excretion

Question 2

What happens when someone’s with COPD or asthma takes propranolol

Answer 2

Bronchocontriction

Question 3

What happens if someone is at risk of falls is taking antihypertensives

Answer 3

Increase risk of falls

(Same with amitriptyline)

Question 4

What happens is someone with bladder output obstruction is taking Oxybutynin

Answer 4

Urinary retention

Question 5

What happens if someone with constipation is taking iron or ca supplements

Answer 5

Exacerbation of constipation

Question 6

What happens if someone with a blood disorder takes NSAIDs

Answer 6

Increased bleeding risk

Question 7

Structured medicine review (SMR)

Answer 7

An intervention to help those with problematic polypharmacy

Question 8

What are the main drug therapy problems

Answer 8

• adherence
• doses too high
• doses to low
• ineffective drug
• no need for the drug
• need for additional therapy

Question 9

Define polypharamcy

Answer 9

Take 5 or more medicines

Question 10

Cause of polyoharamcy

Answer 10

• lack of medication reviews
• lack of communication between prescribed and patient
• muti morbidities

Question 11

What does medicine optimisation encourage - NG5

Answer 11

• medication reviewed
• medication reconciliation
• professional collaborations
• person centred decisions (patient decision aids)

Question 12

When reviewing meds we use the STOPP/START tool. What is this?

Answer 12

STOPP
• identifies inappropriate prescribing in the elderly
• decrease the risk of ADRS

START
• helps prevent neglect of appropriate/necessary medicines

Question 13

Are statins for primary prevention (20mg) beneficial in elderly?

Answer 13

No

Question 14

True or false - START criteria can identify medications that a patient should be on but is not

Answer 14

True

Question 15

True or false - digoxin dose of >125mcrg is appropriate in geriatric patients

Answer 15

False

Question 16

After how many years of take biphosphantes does it show no effectiveness

Answer 16

5> years

Question 17

Examples of drugs which should be used for short term

Answer 17

• BZDs
• PPI
• NSAIDs

Question 18

Medications associates with withdrawel related ADRs

Question 19

Withdrawel of BZDs

Answer 19

• anxiety
• agitation
• delirium
• insomnia
• seizures

Question 20

Withdrawel of corticosteroids

Answer 20

• anorexia
• hypotension

Question 21

Withdrawel of BB

Answer 21

• angina
• hypertension
• tachycardia

Question 22

Withdrawel of anticonvulsants/antiepileptics

Answer 22

• sezuires
• anxiety
• depression

Question 23

< all those have an increased risk of discontinuation syndrome

Question 24

Now, decreased risk of discontinuation syndrome

Question 25

Withdrawel of Analgesics

Answer 25

• fever • insomnia • anxiety •abdominal pain

Question 26

Withdrawel of diuretics

Answer 26

• odema • HTN • HF

Question 27

Withdrawel of - digoxin

Answer 27

• tachycardia • HF

Question 28

Withdrawel of ACEI

Answer 28

• HTN • HF

Question 29

Steps before deprescribing

Answer 29

• check the adherence of the drug • check diagnosis and indication • check the appropriateness • risk of deprescribing • speak with the patient • one drug at a time • monitor

Question 30

Harms of deprescribing

Answer 30

• withdrawal symptoms • rebound of condition • reappearance of symptoms

Question 31

Barriers of deprescribing

Answer 31

• time consuming • if multiple prescribers involved - co-ordination of professionals • from patient: they may think they need the medicine, anxious about cessation

Question 32

Steps for deprescribing BZDs

Answer 32

Step 1 • convert dose of original drug to daily dose of diazepam Step 2 • with low doses - reduce dose by 1-2mg every 2-4 weeks • with high doses - reduce dose by 1 tenth every 1-2 weeks Step 3 • towards the end taper down in steps of 500mcrg then stop

Question 33

Steps for deprescribing antipsychotics Halperidol Risperidone

Answer 33

If daily dose is 500mcrg - stop If daily dose is up to 1mg • halve • then stop If daily dose is over 1mg • halve • halve • then stop

Question 34

How to taper down SSRI or venlaxafine

Answer 34

Reduce dose by 25% every 4-6 weeks

Question 35

How to taper down TCA - eg amitriptyline

Answer 35

Reduce dose by 25% every 4 weeks

Question 36

HTN target in over and under 80s

Answer 36

Over 80 - 150/90 Under 80 - 140/90

Question 37

HTN target in diabetics + those with renal or eye impairments

Answer 37

140/80 130/80 - renal and eye

Question 38

Which drugs increase the risks of falls

Answer 38

• Antihypertensives • Antipsychotics • Andidepressents • Antiepletics • antihistamines

Question 39

Which 2 drugs taken together can cause nephrotoxicity

Answer 39

Paracetamol and simvastin

Question 40

Overdue of constipation medication can lead to..

Answer 40

• diarrhoea • dehydration • hypokalaemia - arrhythmia, electrolyte imbalance

Question 41

Amitriptyline is an anticholinergic, what are the ADRs

Answer 41

Cognitive issues Urinary retention Blurred vision Constipation Dry mouth Falls

Question 42

Which drugs can be used for neuropathic pain?

Answer 42

• amytripyline • duloxitine • gabapentin • pregabalin

Question 43

What drug is used for sezuires

Answer 43

Levetiracetam

Question 44

Instead of using Oxybutynin for urinary incontinence what non pharmacological approach

Answer 44

Incontinence pads

Question 45

Why should metformin not be used in Elderly

Answer 45

Metabolic acidosis

Question 46

If a patient is on sulfonylureas what should this be changed to

Answer 46

SGLT2 inhibitors (Cardioprotective)

Question 47

Tamsulosin and Doxasosin are both alpha blockers , what can this cause

Answer 47

Orthostatic hypotension

Question 48

If a patient is on a TCA what can this be changed to

Answer 48

SSRI