tomi1's version from 2017-07-03 17:42

Section 1

Question Answer
polypharmacy define>5 drugs used by one individual
inappropriate polypharmacypoor life expectancy, contraindication
team involved in medication decisiondr,pharmacist,nurse, patient, relatives
indication for medication reviewside effects, discontinuation, non-adherence

Section 2

Question Answer
what is STOPP/START criteriascreening tool to prompt medication review in elderly
purpose of STOPP/START criteriaprevent inappropriate prescribing or omissions
benefits of STOPP/STARTprevents adverse drug reactions + reduces drug costs
areas often overtreated in elderlyHTN and blood glucose
STOPPscreening tool for older people's potential inappropriate prescriptions
STARTscreening tool to alert doctors to right treatment

Section 3

Question Answer
adverse effects anti-cholinergicscognitive impairment + delirium + constipation + sedation
DRUGS with high anticholingeric propertiesanti-psychotics, anti-depressants, anti-PD
adverse effects NSAIDsGI bleed
biggest systems in STOPPCVS, CNS, MSK, urogenital, fallers
drugs to STOPP in HTNaspirin >150mg, loop diuretics 1st line
antiplatelet to avoid post-strokedipyridamole (postural hypotension)
Cardiovascular drugs in STOPP1.warfarin LT
2.CaB in HF/chronic constipation
3.digoxin if renal failure
CNS drugs in STOP1.TCA with dementia,gluacoma,constipation, opioids,CaB
2.LT sedatives
drugs that affect fallersBNZ

Section 4

Question Answer
biggest systems in STARTCVS, GI,MSK
CVS drugs STARTstatin, ACE (HF/MI/ HTN)
MSK - osteoporosisbisphonsates + Ca + Vit D

Section 5

Question Answer
why medication affects elderly differentlypharmacokinetics and pharmacodynamics
pharmacokinetic factors with ageingABSORPTION=poor (bad swallow, increase ph)
DISTRIBUTION=increase fat, decrease plasma proteins
METABOLISM=decrease liver metabolism
EXCRETION=decrease renal blood flow
pharmacodynamic factors with ageing lower drug dose needed for same affect
drugs with high anticholingeric effect ADs, BNZ, antipsychotics, antiemetics
drugs with med anticholingeric effectneuropathic pain
drugs with low anticholingeric effectACEI, PD drugs, opiates
anticholingeric SEopposite of DUMBELS (cholingeric effects of PNS)
anticholingeric effects on heart-ve iontrope, chronotrope, dronotropy (conduction velocity), increase refractory period
anticholingeric effect on CNShallucinations, psychomotor retardation, sleep disruption

Section 6

Question Answer
adverse drug eventsinjury resulting from drug use
5 catergories of ADR1. Adverse drug reactions 2. Medication errors 3. Therapeutic failures 4. Adverse drug withdrawal events 5. Overdoses
importance of ADR in elderly7% adx in elderly are due to ADR
drugs commonly implicated in ADRNSAIDs,warfarin, diuretics, anitbiotics, opioids, anti-diabetic medication