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Ageing > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

what is meant by pharmacokinetics?

A

absorption, distribution, metabolism, excretion

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2
Q

what is meant by pharmacodynamics?

A

drug action on body

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3
Q

in which 3 conditions should you reduce dose of drugs?

A

age >75
weight <60kg
impaired renal function

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4
Q

what type of environment do acidic drugs need for absorption?

A

acidic

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5
Q

give examples of acidic drugs?

A

phenytoin
aspirin
penicillins

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6
Q

what type of environment do basic drugs require for absorption?

A

basic

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7
Q

what are features of older peoples stomach acid and small bowel surface area which makes more basic drugs be absorbed?

A

stomach acid - more basic

small bowel surface area - decreased

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8
Q

older peoples stomach acid being more basic and small bowel surface area being decreased does not usually pose a problem except in what circumstances?

A

previous GI surgery
NG tube or PEG feed
transdermal patches and oedema
or if more basic drugs absorbed

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9
Q

give examples of basic drugs?

A

diazepam
morphine
pethidine

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10
Q

distribution of drugs can be by which two binding mechanisms?

A

protein binding

lipid binding

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11
Q

what protein binds to acidic drugs?

A

albumin (basic)

elderly = lower

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12
Q

what protein binds to basic drugs?

A

alpha-1 acidic glycoprotein (acidic)

older = higher

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13
Q

what increases lipid binding?

A

increased fat (proportional to muscle mass)

increases VD of lipophilic drugs (eg diazepam, anaesthetics) which give them longer half life

decreases VD of hydrophilic drugs (lithium, digoxin)

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14
Q

what are the two types of drug metabolism?

A

hepatic

renal

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15
Q

what is the problem with hepatic metabolism in elderly?

A

reduced liver function due to decreased liver size, blood flow and disease (eg CHF)

first pass metabolism reduced (eg propranolol)

in general, bio-transforming enzymes reduced in elderly

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16
Q

what is the problem with renal metabolism in elderly?

A

lower GFR

serum creatinine not reliable measure

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17
Q

what is the general principle of pharmacodynamics in elderly?

A

lower doses achieve same effect (common eg alcohol)

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18
Q

what are drugs with narrow therapeutic index (must be checked regularly since helpful and harmful dose very close)?

A 
theophylline 
warfarin 
lithium 
digoxin 
gentamicin 
vancomycin 
phenytoin 
cyclosporin 
carbamazepine 
levothyroxine
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19
Q

what are common side effects of opioids in elderly?

A

constipation - begin lactulose or senna prophylactically

psychomotor function - falls and confusion

20
Q

what are common side effects of steroids in elderly?

A

osteoporosis

steroid induced diabetes

21
Q

what interferes with levothyroxine in elderly and therefore you should not take it at same time?

A

calcium

22
Q

what are common side effects of NSAIDs in elderly?

A

GI haemorrhage
decline in GFR
decreased effectiveness of diuretic and anti-hypertensive agents

give paracetamol in mild OA instead

23
Q

what is common side effect of amlodipine in elderly?

A

oedema

24
Q

if patient has been stable for over a year, what type of therapy should be tried?

A

combination

25
Q

what is beers criteria?

A

list of over 50 meds divided into 3 categories

1) always avoided (eg barbiturates, chlorpropamide)
2) potentially inappropriate (depends on co morbidity)
3) used with caution

26
Q

what is the STOPP tool?

A

screening tool of older peoples potentially inappropriate prescriptions

27
Q

what does STOPP say about loperamide or codeine phosphate?

A

do not give for diarrhoea of unknown cause - may exacerbate constipation or cause toxic megacolon in IBD

28
Q

what does STOPP say about prochlorperazine or metoclopramide?

A

do not give in those with parkinsons - exacerbates it

29
Q

what does STOPP say about stimulant laxatives?

A

do not give in those with intestinal obstruction - risk of bowel perforation

30
Q

what does STOPP say about beta blockers?

A

do not give in combo with verapamil - risk of heart block

31
Q

what does STOPP say about non cardioselective BB (propranolol, sotalol)?

A

do not give in those with COPD - risk of bronchospasm

32
Q

what does STOPP say about calcium channel blockers?

A

do not give in chronic constipation

33
Q

what does STOPP say about dipyridamole?

A

do not give as monotherapy unless intolerant to aspirin and clopidogrel

34
Q

what does STOPP say about atorvastatin?

A

do not give 80mg longer than 6 months post MI

35
Q

what is START tool?

A

screening tool to alert doctors to right treatments

36
Q

what does START say about PPIs?

A

use for GORD or stricture
or >80yo on anti-platelet and SSRIs

also use when aspirin and warfarin used in combo (rare)

37
Q

what does START say about fibre supplement?

A

use for chronic diverticular disease with constipation

38
Q

what does START say about antihypertensives?

A

use where systolic BP is consistently >160mmHg

39
Q

what does START say about ACE inhibitor?

A

use in chronic heart failure or post MI

40
Q

what does START say about warfarin / DOACs?

A

use in chronic AF and following diagnosis of DVT or pulmonary embolism if benefit outweighs risk of treatment

41
Q

adherence to drugs is usually not much worse than younger patients but what are specific issues with elderly compliance?

A

can they open pill container
do they understand when and how to take it
are they remembering

42
Q

what are short term side effects of anti-cholinergic drugs?

A 
confusion 
hallucinations 
tachycardia 
blurred vision 
urinary retention 
constipation 
dizziness 
falls
43
Q

what is long term side effects of anti-cholinergic drugs?

A

increased risk of developing dementia

44
Q

which drugs cause postural hypotension?

A

alpha blocker for BPH and antihypertensive

45
Q

which drugs affect renal function?

A

antibiotic and ACE inhibitor

46
Q

which prescriptions should be time limited?

A 
pain killers 
laxatives 
anti-depressants 
anxiolytics 
antipsychotics 
antihistamines 
antiemetics
47
Q

give 2 examples of prescriptions with no benefit?

A

OA back pain - paracetamol no better than placebo

primary prevention in patients with short life expectancy = statins in advanced malignancy

Ageing (8 decks)

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