Pharmacology

Question 1

Acidic drugs need an _____ environment for absorption

Answer 1

Acidic

Question 2

The stomach in elderly people is more _____ compared to the general population

Answer 2

Basic

Due to less gastric parietal cells that secrete HCl

Question 3

Drug distribution: acidic drugs bind to _____

Answer 3

Albumin

Question 4

Sacropenia causes increased fat with increases the _____ of _____ drugs. This increases their half life such as diazepam

Answer 4

Volume of distribution

Lipophilic

Question 5

Lithium and digoxin are ____ so have a ____ half life and stay in the plasma

Answer 5

Lithium and digoxin are HYDROPHILIC so have a SHORT half life and stay in the plasma

Question 6

Why is 1st pass metabolism different in elderly people compared to the general population?

Answer 6

Physiological decreased liver function

Question 7

Why is drug excretion different in elderly people compared to the general population?

Answer 7

Physiological decrease in GFR

Question 8

A lower therapeutic index causes ….

Answer 8

Increased toxicity

Question 9

Generally in older people, lower doses have the same effect except which drug class which effects HR?

Answer 9

Beta-blockers

Question 10

What do theophylline, warfarin, lithium, digoxin, genta, vanco, phenytoin, cyclosporin, carbamazepine and levothyroxine all have in common?

Answer 10

Low therapeutic index

Question 11

Anticholinergic SEs

Answer 11

Dry mouth (dry as a bone)
Confusion / hallucinations (mad as a hatter)
Tachycardia (flappy as a bird)
Retention (stuffed as a pipe)
Constipation (stuffed as a pipe)
Blurred vision (blind as a bat)
Dizzy 
Plethora (red as a beet)
Hot as a hare

Question 12

What are the SEs of gabapentin in older people?

Answer 12

Dizzy
Fatigue
Vision
Confusion

Question 13

Amlodipine main SE

Answer 13

Ankle edema

Question 14

What drug should be given to people over 80 on an antiplatelet or SSRI?

Answer 14

PPI

Question 15

What drug should be co-administered with opioids in elderly people and why?

Answer 15

Lactulose / senna

Constipation prophylaxis

Question 16

What drug should be given instead of NSAIDs for mild OA Mx in the elderly? And why?

Answer 16

Paracetamol

Since lowered GFR and increased risk GI haemorrhage

Question 17

What is the WHO pain ladder?

Answer 17

NSAID
Mild opioid eg codeine
Strong opioid eg morphine

+-Adjuvant

Question 18

Give 2 examples of adjuvant pain killers?

Answer 18

Gabapentin

Tricyclics eg amitriptyline

Question 19

Give examples of a mild and strong opioid

Answer 19

Mild codeine

Strong morphine

Question 20

What are the main SEs of morphine?

Answer 20

Withdrawal
Resp depression
Emesis

Question 21

What drug can be given for morphine induced nausea?

When is it contraindicated?

Answer 21

Metoclopramide

CI Parkinson’s since DA antagonist

Question 22

What drug can reverse morphine?

Answer 22

Naloxone

Question 23

What is the PO version or morphine called?

Answer 23

Oromorph

Question 24

What version of morphine is prescribed for background pain?

Answer 24

PO MST

Question 25

What version of morphine is prescribed for breakthrough pain?

Answer 25

PO oromorph PRN

Question 26

How does opioid toxicity present?

Answer 26

Hallucinate, vivid dreams, twitch myoclonus, drowsy

Question 27

What drugs should be stopped in a palliative PTx who is currently dying?

Answer 27

Statins and anticoagulants

Question 28

What anticipatory drug is given for nausea in a palliative PTx?

Answer 28

Levomepromazine 2.5mg IJ

Question 29

What anticipatory drug is given for distress in a palliative PTx?

Answer 29

Midazolam 2mg SUB

Question 30

What anticipatory drug is given for secretions in a palliative PTx?

Answer 30

Buscopan aka hyoscine butylbromide IJ 20mg

Question 31

What is the name for vit D supplements?

Answer 31

Accrete

Question 32

Why are PO NSAIDs not given long term in the elderly?

Answer 32

Kidney function and gastric ulceration

Question 33

"Food tasting funny" could be due to

Answer 33

Thrush or Fe anaemia

Question 34

Prochlorperazine & metoclopramide risk exacerbating which chronic condition?

Answer 34

Parkinson's

Question 35

What are the two 1st line drug options for diarrhoea of unknown cause

Answer 35

Loperamide or codeine phosphate

Question 36

What drug should be given for chronic symptomatic diverticular disease w/ constipation

Answer 36

Fibre supplement

Question 37

BB should not be given to PTx with what common chronic condition that has a strong association with smoking and chest infections?

Answer 37

Stop BB if COPD

Question 38

What antihypertensive shouldn't be given to patients with chronic constipation?

Answer 38

CCB

Question 39

What antihypertensive is 1st line in CHF?

Answer 39

ACEI

Question 40

What antihypertensive is 1st line post MI?

Answer 40

ACEI

Question 41

If PTx with benign prostatic hyperplasia and HTN is prescribed an alpha blocker and antihypertensive, what side effect are they at high risk of?

Answer 41

Postural hypotension

Question 42

When are statins a futile prescription?

Answer 42

Short life expectancy

Question 43

Post VTE, what drug should be used long term?

Answer 43

Warfarin

Question 44

What is the anticoagulant of choice in AF?

Answer 44

Warfarin long term

Question 45

In adult a standard fluid bolus is 500ml, what is a standard fluid bolus in the elderly?

Answer 45

250ml

Question 46

What does MST stand for?

Answer 46

Morphine slow release tablet | the commonest strong opioid

Question 47

What is the only opioid safe in CKD?

Answer 47

Fentanyl

Question 48

Is morphine eliminated by the kidneys or liver?

Answer 48

Kidneys

Question 49

When verifying death, you must check if someone _____ since it will explode if they're cremated

Answer 49

If they have a pacemaker

Question 50

A bolus dose of morphine one _____ of the daily morphine dose

Answer 50

1 sixth

Question 51

How does opioid toxicity present?

Answer 51

Hallucinations, myoclonus, resp depression, drowsiness

Question 52

In opioid toxicity, naloxone should be given if _____

Answer 52

RR less than 8

Question 53

What is the indication of loperamide?

Answer 53

Diarrhea

Question 54

Are acidic or basic drugs more easily absorbed in the elderly?

Answer 54

Basic