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30 Cards in this Set
- Front
- Back
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What main physiological factors lead to larger drug effect in the elderly?
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1. Reduced muscle:fat ratio (change in VD)
2. Reduced hepatic blood flow (decreased metabolism) 3. Reduced protein binding (increased free drug) 4. Reduced renal function (reduced excretion) |
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Define polypharmacy
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>4 drugs daily
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Problems with polypharmacy...(4)
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Side effects
Drug interactions Memory Falls and fractures |
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Dangerous drugs....
2 groups of sedatives |
Benzos
Antipsychotics |
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Dangerous drugs...
Narrow therapeutic index (4) |
Digoxin
Aminophylline Lithium Warfarin |
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Dangerous drugs...
Anti-muscurinic SE (2) |
Amitryptiline
Oxybutynin |
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Dangerous drugs...
Nephrotoxic (2) |
Gentamicin
Vancomycin |
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Dangerous drugs...
Long-acting (1) |
Glibenclamide (sulfonylurea)
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Why are extrapyramidal effects of the Parkinsonian type more commmon in the elderly?
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Decrease in dopaminergic cells in basal ganglia-blockage of DA receptors effected by lower concentrations of antipsychotics
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Cholinergic neurones are deficient in AD and drugs with anticholinergic effects will further impair the mechanisms, producing memory loss.
T/F? |
T
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Receptor numbers and neurotransmitters are decreased in the eldely. Which is the exception?
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Monoamine oxidase (enzyme involved in breakdown of neutotransmitters)
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With aging there is an increase in gastic pH.
T/F? |
F - Decrease
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How much does body water decrease in proportion to body mass in the elderly?
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From 1/4 of body mass to less than 1/5
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How much do albumin levels fall by in the elderly?
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About 1/4
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Why is the effect of drugs in the brain lessened?
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The brain perfusion is poor so the distribution is impaired
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Hepatic bloodflow in the over-65s is decreased to about 3/4 when compared with younger people.
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F - Decreased to 1/3
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Type 2 metabolic processes in the liver such as glucuronidation are slower in the elderly.
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F - Hydroxylation and demethylation are reduced;type 2 metabolic processes are little affected
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What is the GFR in over-70s compared to young adults?
a) 10% b) 30% c) 50% d) 70% |
c) 50%
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Serum creatinine is a reliable index of kidney function in the elderly.
T/F? |
F - Creatinine clearance is much more reliable as body mass also decreases with age
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Which drug is most affected by renal changes?
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Lithium - almost entirely excreted in urine
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Think about the side effects of TCAs in old people with respect to alpha-adrenoceptors, histamine receptors and cholenergic receptors
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Alpha-adrenoceptor blockage - Postural hypotension
Antihistaminic - Sedation Anti-cholinergic - Impaired cognitive function, blurred vision, constipation |
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SSRI side effects specific to elderly (2)
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Extrapyramidal - akathisia and tremors
Hyponatraemia due to syndrome of inapproropriate ADH |
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Antipsycholtic side-effects which are greater in the elderly
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Tarditive dyskinesia -greater risk
Delerium Drug-induced Parkinsonism (esp with AD or LBD) |
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Women are more likely than men to recieve a hypnotic
T/F? |
T
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Once on hypnotics, few elderly people are considered suitable for withdrawal
T/F? |
T
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Prescription of hypnotics is suitable for an elderly person and should not be avoided.
T/F? |
F - Prescription should be avoided in this group as addiction, ataxia, confusion and falls increased
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Lithium should not be prescribed in the elderly.
T/F? |
F - Requires careful titration and monitoring
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Lithium toxicity can occur at below 1 mmol/L in the elderly
T/F |
T
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What level of lithium should be aimed at?
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0.4-0.6mmol/L
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5 factors increasing risk of lithium toxicity in the elderly.
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1.concurrent prescription of diuretics
2.intercurrent illness 3.worsening renal failure 4.failing compliance 5.confusion |
