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19 Cards in this Set
- Front
- Back
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Reasons for increased risk of ADR in the elderly |
Age related body changes Polypharmacy - interactions Compliance and concordance issues |
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The majority of ADR are |
Dose dependant and therefore predictable and preventable in majority of cases |
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Most common medications associated with ADRs in the elderly |
Opioids NDAIDs Anticholinergics Benzodiazepines |
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The prescribing cascade is |
Prescribing a secondary medication for a perceived disease or condition which is actually an ADR to initial medication |
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Name the four components of Pharmacokinetics |
Absorption Distribution Metabolism Elimination |
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Factors affecting absorption? |
Interactions eg Food, Gastric pH Rate of ab - lower peak conc etc Surface area Solubility Dissolution Blood flow Intestinal motility |
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Swallowing difficulties possible effects |
Crushed or chewed medication may lose protective enteric coating and be absorbed in the stomach rather than the gut etc |
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Factors affecting Distribution |
Regional blood flow Lipid solubility Percentage of body water Body fat |
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In the elderly there is a decrease in the level of plasma protein |
Albumin |
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The albumin decrease results in a X binding capacity and therefore X clearance and X total concentration |
Lower Higher Lower |
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Blood flow affects hepatic... |
Drug metabolism and elimination |
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Blood flow to liver and hepatic mass X with age and common disease states in the elderly. |
Decreases |
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Other factors affecting Metabolism |
Gender Comorbid conditions Drug interactions Race Frailty Smoking/Diet |
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Most important change affecting Elimination |
Renal excretion |
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Renal drug excretion depends on |
Renal blood flow Glomerular filtration rate Urine flow rate and pH |
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Affects of ageing on Kidney function |
Decreased kidney size/mass Decreased renal blood flow Decreased number of functional nephrons Decreased tubular secretion |
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What is pharmacodynamics? |
Changes in receptor sensitivity Changes in receptor number Changes in hormone level |
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Common age related changes to homeostasis |
Baroreceptor reflex with blunting of reflex tachycardia Postural control Thermoregulation Reserve of cognitive function Immune response- infection prone |
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Medication review- No Tears |
Need and indication Open questions
Tests and monitoring Evidence and guidelines Adverse events Risk reduction or prevention Simplification and switches |
