Therapeutics- Prescribing in Special Groups- Old People Flashcards Preview

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Flashcards in Therapeutics- Prescribing in Special Groups- Old People Deck (14)
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1
Q

What is physiological ageing?

A

Time-related loss of functional units within an organ system (e.g. nephrons, neurones)

2
Q

What is frailty?

A

Progressive physiological decline in multiple organ systems results in loss of physiological reserve and increased vulnerability to death and disease

3
Q

What is polypharmacy?

A

Concurrent use of multiple medications- typically defined as more than 4

4
Q

What changes affect the absorption of drugs in the elderly?

A

Decreased gastric motility
Decreased gastric blood supply and regional blood supply
Decreased saliva production
Increased gastric pH

5
Q

How does first pass metabolism change in the elderly?

A

Decreases due to reduced hepatic blood flow

6
Q

How does body fat change with age?

A

It increases- causing the Vd for lipid soluble drugs to increase
Diazepam is an example of a lipid soluble drug

7
Q

How does body water change with age?

A

It decreases- causing the Vd of water soluble drugs to decrease so concentrations can increase

8
Q

How does plasma protein concentration change with age?

A

Plasma protein concentration reduces- meaning the concentration of free drug can be higher. E.g. Phenytoin (used for epilepsy)

9
Q

How does drug metabolism change with increasing age?

A

Reduced activity of cytochrome P-450 reduces the metabolism of some drugs. This causes reduced metabolic clearance and reduced activation of pro-drugs

10
Q

How does elimination change with increasing age?

A

Renal function reduces with age so there is reduced clearance of renally excreted drugs

11
Q

What are the geriatric giants?

A

Instability
Immobility
Impaired Intellect/Memory
Incontinence

12
Q

What is the STOPP/START Criteria?

A

Used to decide wether to add or remove medications for elderly people

13
Q

What drugs should be avoided with renal impairment?

A

NSAIDs
Amino glycosides- Gentamicin
Metformin- Increased risk of lactic acidosis
Nitrofurantoin- Not effective if eGFR<45mls/min
Potassium supplmentation/potassium sparing diuretics- risk of hyperkalaemia
Lithium- renally excreted with a narrow therapeutic index

14
Q

Which drugs should be avoided in hepatic impairment?

A

Any drugs that precipitate hepatic encephalopathy
Sedatives
Diuretics- can cause hypokalaemia
Drugs that cause constipation