Pharmacy and The Elderly Patient

Question 1

Absorption of oral medication changes

Answer 1

Increased gastric pH - reduced gastric acid secretion
Delayed gastric emptying
Reduced circulation in the GIT
Reduced surface area - reduction in the number of absorbing cells in the intestine
Decreased gastric motility

Question 2

Volume of distribution - blood flow to the body’s tissues

Answer 2

Dependent on blood flow / body composition / properties of the medicines
Increase in age - increase in fat / decrease in body mass and body water
E.g. water soluble will have smaller Vd - high concentration of drugs
E.g lipid soluble will have higher Vd - prolonged half-life

Question 3

Protein binding / Albumin

Answer 3

Bound medication cannot pass through membranes - not pharmacologically active
Unbound medication - pharmacologically active
Albumin decrease with age and can be exacerbated by poor nutrition - leads to toxicity

Question 4

Metabolism

Answer 4

Liver volume decreases with age
CYP450 activity decrease with age
Hepatic blood flow decrease with age
Drug dosing impact in severe liver impairment

Question 5

Excretion

Answer 5

Decline in renal function - cause of toxicity

Question 5

Medicines most associated with harm / hospital admission (ANDA)

Answer 5

Antiplatelets
NSAIDs
Diuretics
Anticoagulants

Question 6

Medicine-related falls linked to S/E

Answer 6

Sedation - Benzodiazepines, Opiates
Hypotension - ACE, GTN
Bradycardia - B-blockers, Diltiazem
Syncope - GTN
Constipation - Anticholinergics, Opiates
Delirium - Opiates, TCA

Question 7

Falls: Alpha-blockers

Answer 7

Hypotension
Dizziness

Question 8

Falls: Antidepressants

Answer 8

Arrhythmias
Dizziness
Hyponatraemia
Postural hypotension
Sedation

Question 9

Falls: Antiepileptics

Answer 9

Ataxia
Dizziness
Impaired balance
Somnolence

Question 10

Falls: Antihistamines

Answer 10

Blurred vision
Confusion
Dizziness
Drowsiness

Question 11

Falls: Antipsychotics

Answer 11

Blurred vision
QT prolongation
Dizziness
Extrapyramidal S/E
Sedation

Question 12

Falls: Benzodiazepines

Answer 12

Cognitive impairment
Hangover effect
Psychomotor impairment

Question 13

Falls: Centrally acting hypertensives - Methyldopa / Clonidine

Answer 13

Sedation
Postural hypotension

Question 14

Falls: Diuretics

Answer 14

Electrolyte disturbances
Hypotension
Postural hypotension
Urinary disturbances

Question 16

Falls: Opioids

Answer 16

Impaired balance
Sedation
Slowed reactions

Question 17

Falls: Incontinence medications

Answer 17

Dizziness
Hypotension
Postural hypotension

Question 18

Falls: Vasodilators

Answer 18

Dizziness
Postural hypotension
Hypotension

Question 19

Postural hypotension

Answer 19

Drop in systolic BP of 20mmHg

Question 20

Frailty

Answer 20

Whether a person has the mental and physical reserves to recover to their previous level of functioning if they experience an illness or injury

Question 21

Signs of frailty

Answer 21

Low energy expenditure
Reduced muscle strength
Reduced gait speed
Self-reported exhaustion
Unintentional weightloss