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Geriatrics > Drugs and Polypharmacy > Flashcards

Drugs and Polypharmacy Flashcards

1
Q

Define polypharmacy

A

The prescription of five or more drugs at any given time

Polypharmacy can also refer to the inappropriate or unnecessary prescription of drugs

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2
Q

Why is polypharmacy undesirable?

A

Polypharmacy increases the risk of adverse effects associated with the medications, with patients on ten or more medications being almost certain to experience an adverse effect

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3
Q

What are the common ADRs in the elderly?

A
  • Falls
  • Cognitive Loss /delirium
  • Dehydration
  • Incontinence
  • Depression
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4
Q

What are the main complications of an ADR in the elderly?

A
  • Loss of functional capacity
  • Poor quality of life
  • Nursing home placement
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5
Q

What are the reasons behind older people having more prescriptions?

A
  • More acute & chronic disease
  • More doctors visits
  • Drugs often given to counteract a side effect of another drug
  • Several other factors arising from prescribers, patients and the system
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6
Q

Why are ADRs sometimes missed in the elderly and what is the complication of this?

A

Many ADRs can mimic affects of ageing

Missed ADRs can cause prescription cascades

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7
Q

What are the factors related to the healthcare provider that contribute to polypharmacy in the elderly?

A
  • No med review with patient on regular basis
  • Presumes that patient expects meds
  • Prescribes without sufficiently investigating clinical situation
  • Evidence that a particular drug is the “best” drug for a problem
  • Provides unclear, complex or incomplete instructions about how to take meds
  • Ordering automatic refills
  • Lack of knowledge of geriatric clinical pharmacology
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8
Q

What are the most commonly offending drugs of ADRs in the elderly?

A

Anticholinergics and sedatives

Together make up 80% of ADRs in elderly

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9
Q

How do pharmacokinetics change with age?

A

Absorption- physiological changes occur that alter the rate but not extent of absorption from the GI tract. These include a reduction in production of saliva.
Distribution- body composition changes (reduced muscle mass, increased adipose tissue, reduced body water), protein binding changes and increased permeability of the blood-brain barrier
Metabolism- hepatic metabolism affected by decreased liver mass and blood flow
Excretion- renal function decreases with age so clearance decreases

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10
Q

How do pharmacodynamics change with age?

A

Increased sensitivity to particular medicines due to the following:
• Change in receptor binding
• Decrease in receptor number
• Altered translation of a receptor initiated response into a reaction

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11
Q

What are the principles of prescribing in the elderly?

A
  • Be clear about diagnosis to avoid prescribing for ADRs
  • Consider whether drug therapy is best option
  • Start at low doses
  • Think about side effects of drug specific to elderly
  • Review new drugs and check they are achieving their aim
  • Review all prescriptions regularly and remove any non-beneficial drugs
  • Try to keep regimens simple
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12
Q

What tools are useful in prescribing for the elderly?

A

The best tool for prescribing in the elderly is the NHS Scotland polypharmacy guidance. STOPP/START criteria is useful in reducing ADRs.

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13
Q

What are the common reasons for deprescribing?

A
  • Adverse drug reaction
  • Drug-drug interaction
  • Drug-disease interaction
  • Better alternative
  • Not effective
  • Not indicated
  • Not evidence-based
  • Minimise polypharmacy
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14
Q

What are the increased risks of psychiatric medicines in the elderly?

A

Increased effects of benzodiazepines cause falls and confusion
Increased adverse effects from anti-psychotics such as postural hypotension, stroke, confusion and movement disorders

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15
Q

What are the increased risks of analgesia in the elderly?

A

Increased sensitivity to opioids

Increased adverse events with NSAIDs including renal impairment and GI bleeding

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16
Q

What are the increased risks of cardiovascular medicines in the elderly?

A 
Increased toxicity of digoxin
Altered effects of diuretics
Anti-hypertensives causing exaggerated effects on BP and heart rate (morel likely to cause postural hypotension) 
Renal AEs
Increased sensitivity to anti-coagulants
17
Q

What are the possible adverse events from antibiotic prescription in the elderly?

A
  • Diarrhoea and c. diff infection
  • Blood dyscrasias (trimethoprim, co-trimoxazole)
  • Delirium (quinolones)
  • Seizures
  • Renal impairment (aminoglycosides)

Geriatrics (6 decks)

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