Polypharmacy

Question 1

Guidelines for prescribing in older patients

Answer 1

Carry out regular medication review
- communicate changes to GP, patient and carers
Stop any drugs that aren’t indicated
Ensure new medications clear and relevant indications
Avoid medications which have deleterious effects in older people if possible - benzodiazepines
Use lowest effective dose
Consider risk of anticoagulants and falls
Simple regimes and appropriate administration system
- once daily or once weekly
Consider non-pharmacological treatments
Try to avoid treating adverse drug reactions with other medications - stop initial drug
Explore adherence

Question 2

Medications to consider prescribing in elderly

Answer 2

Calcium and vitamin D (Adcal D3) for frail, elderly patients with hx of falls
Bisphosphonates - secondary prevention of osteoporosis
- risk of atypical femoral fractures with long term use
- use FRAX tool to calculate osteoporosis risk ‘ 10 year fracture risk due to decreased bone density

Question 3

Drugs which may increase falls risk

Answer 3

Antidepressants
- TCAs - amitriptyline
- SSRIs - citalopram, fluoxetine, sertraline
- others - trazadone, mirtazapine, venlafaxine
Antipsychotics
- chlorpromazine, haloperidol, lithium, promazine, quetiapine, olanzapine, risperidone
Antiemetics
- prochlorperazine, cyclizine, metoclopramide, ondansetron
Sedative and hypnotics
- temazepam, diazepam, lorazepam, zopiclone
Parkinson’s drugs
- co-beneldopa, co-careldopa, rivastigmine
Muscle relaxants
- baclofen, dantrolene, tizanidine
Anticholinergic side effects
- prochlorperazine, oxybutynin, procyclidine
CVS drugs
- ACEi, angiotensin II antagonists - ramipril, losartan, candesartan
- Vasodilators - nifedipine, GTN
- Diuretics - bendroflumethiazide, furosemide, spironolactone
- Beta-blockers - bisoprolol, propranolol
- Alpha-blockers - doxazosin, tamsulosin
Opioids
- codeine, tramadol, morphine, fentanyl
Anticonvulsants
- carbamazepine, valproate, gabapentin, pregabalin, lamotrigine