Pharmacokinetics and Pharmacodynamics in Aging
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Questions and Answers

Which age group is most affected by pharmacokinetic and pharmacodynamic changes?

  • Adults
  • Pediatric patients
  • Older persons (correct)
  • Pregnant women

    • What is a common consequence of polypharmacy in older persons?

  • Improved cognitive function
  • Reduced risk of ADRs
  • Increased risk of ADRs (correct)
  • Faster drug elimination

    • What is the primary mechanism of action of anticholinergic drugs?

  • Enhancing the action of serotonin
  • Blocking the action of acetylcholine (correct)
  • Blocking the action of dopamine
  • Inhibiting the action of norepinephrine

    • Which of the following conditions is NOT treated with anticholinergic drugs?

    <p>Hypertension</p> Signup and view all the answers

    What is a potential consequence of prescribing anticholinergic agents to older persons?

    <p>Increased mortality</p> Signup and view all the answers

    What is a common adverse effect of anticholinergic drugs in older persons?

    <p>Cognitive impairment</p> Signup and view all the answers

    What is a potential interaction that can increase the risk of ADRs in older persons?

    <p>All of the above</p> Signup and view all the answers

    Why should anticholinergic drugs be avoided in older persons?

    <p>They are associated with adverse effects</p> Signup and view all the answers

    What is the purpose of anticholinergic burden scales?

    <p>To aid clinicians in their decision-making during a medication review</p> Signup and view all the answers

    What is the significance of a score of 3 or more on the anticholinergic burden scale?

    <p>The patient is at significant risk of adverse effects</p> Signup and view all the answers

    Which of the following medications has a consistent score of 3 on some anticholinergic burden scales?

    <p>Clomipramine</p> Signup and view all the answers

    Why does the American Geriatrics Society recommend avoiding the use of anticholinergic medications in older persons?

    <p>Because older persons are more likely to experience adverse side-effects from anticholinergics</p> Signup and view all the answers

    What is the purpose of the Anticholinergic Burden Calculator?

    <p>To aid clinicians in their decision-making during a medication review</p> Signup and view all the answers

    Which of the following is a recommended alternative to sedating antihistamines?

    <p>Fexofenadine</p> Signup and view all the answers

    What is the cumulative anticholinergic burden score of Tanya's medications before the medication review?

    <p>12</p> Signup and view all the answers

    Which of the following medications was stopped/weaned due to drug errors identified during the medication review?

    <p>Sertraline, Tolterodine, and Aripiprazole</p> Signup and view all the answers

    What is the total anticholinergic burden score of Tanya's medications after the medication review?

    <p>7</p> Signup and view all the answers

    What is the main limitation of anticholinergic burden scales?

    <p>All of the above</p> Signup and view all the answers

    What is the potential reason for the patient's epistaxis?

    <p>Taking DAT</p> Signup and view all the answers

    What is the correct drug-drug interaction?

    <p>azathioprine and allopurinol</p> Signup and view all the answers

    What is the pharmacodynamic change that results in increased responsiveness to benzodiazepines?

    <p>Changes in the neurotransmitter gamma-aminobutyric acid (GABA)-benzodiazepine receptor complex</p> Signup and view all the answers

    What is the result of pathological changes in organs?

    <p>Changes in receptor binding</p> Signup and view all the answers

    What is the predictor of polypharmacy?

    <p>Number of co-morbidities</p> Signup and view all the answers

    What is the definition of polypharmacy?

    <p>Taking more than five medications</p> Signup and view all the answers

    What is the risk associated with polypharmacy?

    <p>Both A and B</p> Signup and view all the answers

    What is the purpose of the 7 Steps framework?

    <p>To center on what 'matters' to the patient</p> Signup and view all the answers

    What is Tanya's level of frailty?

    <p>Moderate frailty</p> Signup and view all the answers

    What is the indication of Tanya's admission?

    <p>Epistaxis and a fall</p> Signup and view all the answers

    What is the primary purpose of the 'sick day rule'?

    <p>To provide guidance on medication cessation during dehydration</p> Signup and view all the answers

    Which medication class can increase the likelihood of dehydration?

    <p>Diuretics</p> Signup and view all the answers

    What is a potential consequence of dehydration in patients taking metformin?

    <p>Lactic acidosis</p> Signup and view all the answers

    What percentage of unplanned hospital admissions due to adverse drug events are estimated to be preventable in older patients?

    <p>25%</p> Signup and view all the answers

    What is a common adverse effect of anticholinergic medications in older patients?

    <p>Cognitive impairment</p> Signup and view all the answers

    What is a potential interaction between NSAIDs and other medications?

    <p>Increased risk of heart failure</p> Signup and view all the answers

    What is a potential consequence of prescribing α1-adrenergic receptor antagonists to older patients?

    <p>All of the above</p> Signup and view all the answers

    Which medication can increase the risk of ADRs when used with clarithromycin?

    <p>Simvastatin</p> Signup and view all the answers

    What is a tool used by pharmacists to determine drug-drug and drug-disease interactions?

    <p>Stockley's Interactions Checker</p> Signup and view all the answers

    What is the name of the patient who was admitted to the hospital with epistaxis and was found to be taking OTC ibuprofen?

    <p>Tanya</p> Signup and view all the answers

    What was the outcome of medication optimization in relation to the ACB score?

    <p>It decreased from 7 to 3</p> Signup and view all the answers

    What is the estimated error rate among patients prescribed ten or more medications?

    <p>47%</p> Signup and view all the answers

    What is the primary indication for Tanya's prescription of Theophylline?

    <p>Chronic obstructive pulmonary disease</p> Signup and view all the answers

    What is the definition of a medication error, according to the National Coordinating Council for Medication Error Reporting and Prevention?

    <p>Any preventable event that may cause or lead to inappropriate medication use or patient harm</p> Signup and view all the answers

    What is the purpose of the 7-Steps to appropriate polypharmacy?

    <p>To determine the most essential medications for a patient</p> Signup and view all the answers

    What percentage of medication incidents reported resulted in actual patient harm?

    <p>16%</p> Signup and view all the answers

    What is the estimated global cost associated with medication errors?

    <p>US$42 billion annually</p> Signup and view all the answers

    What is the primary reason for Tanya's prescription of Aripiprazole?

    <p>To treat her depression</p> Signup and view all the answers

    Why is generic prescribing recommended?

    <p>To avoid confusion and improve patient safety</p> Signup and view all the answers

    What is the primary mechanism of action of Telmisartan?

    <p>To reduce blood pressure and alleviate heart failure</p> Signup and view all the answers

    At which points in the medication process can errors occur?

    <p>At multiple points, including ordering, documenting, transcribing, dispensing, administering, and monitoring</p> Signup and view all the answers

    What is the primary indication for Tanya's prescription of Oxybutynin?

    <p>To manage her overactive bladder</p> Signup and view all the answers

    What is the purpose of the first step in the 7-Steps to appropriate polypharmacy?

    <p>To ask the patient what matters to them</p> Signup and view all the answers

    What was the reason for Tanya's unnecessary medication with aripiprazole?

    <p>A mix-up with her daughter's prescription</p> Signup and view all the answers

    Why is medication reconciliation important?

    <p>To reduce the potential for errors at interfaces of care</p> Signup and view all the answers

    What is the primary indication for Tanya's prescription of Brimica genuair?

    <p>To treat her chronic obstructive pulmonary disease</p> Signup and view all the answers

    What is the importance of confirming an accurate list of medication?

    <p>To avoid confusion and reduce the potential for errors</p> Signup and view all the answers

    What is the primary mechanism of action of Bisoprolol?

    <p>To reduce blood pressure and alleviate heart failure</p> Signup and view all the answers

    What is the primary indication for Tanya's prescription of Duloxetine?

    <p>To manage her depression</p> Signup and view all the answers

    What is the primary purpose of the 7-Steps to appropriate polypharmacy in relation to the patient?

    <p>To establish person-centred goals and prioritize the patient's needs</p> Signup and view all the answers

    What is the primary reason for not stopping essential drug therapy without specialist input?

    <p>To ensure the patient does not experience rapid symptomatic decline</p> Signup and view all the answers

    What is the main goal of reviewing the indication of other medications?

    <p>To determine if therapeutic goals are being achieved</p> Signup and view all the answers

    What is the benefit of reducing the dose of a medication?

    <p>It reduces the burden of medication on the patient</p> Signup and view all the answers

    What is the primary goal of informing relevant healthcare and social care professionals of changes in treatments?

    <p>To optimize patients' treatment to achieve their preferred outcomes</p> Signup and view all the answers

    What is the estimated savings in medication costs for every pound invested in the review process?

    <p>£2.38</p> Signup and view all the answers

    What is an important factor to consider when assessing the effectiveness of a medication?

    <p>The patient's perception of the medication's effectiveness</p> Signup and view all the answers

    What is the definition of inappropriate polypharmacy according to the National Institute on Aging?

    <p>The use of excessive or unnecessary medications</p> Signup and view all the answers

    What is a common adverse drug reaction (ADR) in older adults?

    <p>Delirium</p> Signup and view all the answers

    What should be considered when deciding to change a medication for cost reasons?

    <p>The medication's effectiveness, safety, and adherence</p> Signup and view all the answers

    What is the primary focus of the King's Fund's paper on polypharmacy and medicines optimization?

    <p>Optimizing medication use to achieve better patient outcomes</p> Signup and view all the answers

    What is an important step in implementing the plan agreed upon with the patient?

    <p>Liaising with caregivers and providing clear instructions</p> Signup and view all the answers

    According to the Scottish Government Polypharmacy Model of Care Group, what is a critical aspect of appropriate polypharmacy?

    <p>Prescribing medications according to best evidence</p> Signup and view all the answers

    What is the estimated reduction in medication prescribed to residents in care homes participating in the Northumbria NHS Trust's medication review project?

    <p>17%</p> Signup and view all the answers

    What should be discussed with the patient when agreeing on the plan?

    <p>The outcomes of the review in terms of medication changes</p> Signup and view all the answers

    What is the primary benefit of reducing the number of medications prescribed to patients?

    <p>Improving patient outcomes</p> Signup and view all the answers

    Why is it important to identify medications that are deemed essential to the patient?

    <p>To understand the patient's perspective on their medication</p> Signup and view all the answers

    What is the primary goal of the medication review process?

    <p>To identify opportunities for medication optimization</p> Signup and view all the answers

    What is the definition of appropriate polypharmacy according to the King's Fund?

    <p>Prescribing medications according to best evidence</p> Signup and view all the answers

    What is the primary focus of the Scottish Polypharmacy Model of Care Group?

    <p>Optimizing medication use to achieve better patient outcomes</p> Signup and view all the answers

    What is the estimated time saved by nurses in administering medications after participating in the Northumbria NHS Trust's medication review project?

    <p>1 hour</p> Signup and view all the answers

    What is a key characteristic of appropriate polypharmacy?

    <p>Drugs are prescribed for specific therapeutic objectives agreed with the patient.</p> Signup and view all the answers

    In which situation does inappropriate polypharmacy occur?

    <p>When a patient is taking multiple medications with no evidence-based indication.</p> Signup and view all the answers

    What is a consequence of inappropriate polypharmacy?

    <p>Patients are at an unacceptably high risk of adverse drug reactions.</p> Signup and view all the answers

    What is a requirement for appropriate polypharmacy?

    <p>Patients must be motivated and able to take all medicines as intended.</p> Signup and view all the answers

    What is an important consideration in optimizing drug therapy for appropriate polypharmacy?

    <p>Minimizing the risk of adverse drug reactions.</p> Signup and view all the answers

    What is a key difference between appropriate and inappropriate polypharmacy?

    <p>The therapeutic objectives of the medications.</p> Signup and view all the answers

    Study Notes

    Pharmacokinetic and Pharmacodynamic Changes in Older Adults

    • With advanced age, regulatory processes that ensure functional integration between cells and organs are impaired, leading to changes in pharmacokinetics and pharmacodynamics.

    Pharmacokinetic Changes

    • Affect how the body handles drugs, including absorption, distribution, metabolism, and elimination.
    • Impaired liver and kidney function, decreased muscle mass, and altered body composition contribute to pharmacokinetic changes.

    Pharmacodynamic Changes

    • Affect drug actions on the body, including changes in receptor binding, postreceptor effects, and adaptive homeostatic responses.
    • Increased permeability of the blood-brain barrier, decreased responsiveness to beta-agonists, and increased sensitivity to anti-hypertensives are examples of pharmacodynamic changes.

    Anticholinergic Drugs

    • Associated with adverse effects in older persons, including cognitive impairment, confusion, delirium, and increased mortality.
    • Avoid prescribing anticholinergic drugs in older persons, and recommend alternative medications where possible.
    • Anticholinergic burden scales, such as the Anticholinergic Cognitive Burden (ACB) scale, can help clinicians assess the risk of adverse effects.

    Medication Errors and Polypharmacy

    • The rate of medication errors increases with the number of medicines prescribed, with 47% of patients taking ten or more medications experiencing a prescribing or monitoring error.
    • Medication errors can occur at any stage of the medication process, including ordering, documenting, transcribing, dispensing, and administering.
    • Polypharmacy is a major risk factor for adverse drug reactions, with 25% of unplanned hospital admissions in older adults being preventable.

    Adverse Drug Reactions (ADRs)

    • Commonly cause adverse clinical outcomes in older people, with 8.6 million unplanned hospital admissions in Europe annually.
    • ADRs can be caused by drug-drug and drug-disease interactions, as well as polypharmacy.
    • Older people are at increased risk of ADRs due to physiological changes associated with aging, including decreased counterregulatory mechanisms.

    Pharmacodynamic Changes and Age

    • Changes in drug-receptor interactions, adaptive homeostatic responses, and pathological changes in organs can affect drug actions on the body.
    • Examples include increased sensitivity to benzodiazepines, decreased response to beta-agonists, and increased susceptibility to postural hypotension.

    Polypharmacy and its Risks

    • Defined as taking five or more medications, with excessive polypharmacy being ten or more medications.
    • Predictors of polypharmacy include the number of co-morbidities and the number of prescribers involved.
    • Risks associated with polypharmacy include cognitive impairment, falls, immobility, incontinence, multi-morbidity, and reduced quality of life.### Patient Information
    • Tanya is an 82-year-old patient with multiple medical conditions.
    • She has Chronic Obstructive Pulmonary Disease (COPD), Stage III, with a forced expired volume (FEV) of 1-38% and is on long-term oxygen therapy (LTOT).
    • Other medical conditions include overactive bladder, vaginal prolapse, congestive cardiac failure (CCF), depression, vitamin D deficiency, intermittent hemodialysis (IHD), angina, and hypercholesterolemia.

    Medications

    • Folic acid (5 mg daily) - B group vitamin, vitamin B9
    • Desunin (colecalciferol) (1600 units daily) - Vitamin D
    • Duloxetine (60 mg daily) - Antidepressant
    • Atorvastatin/ezetimibe (10/40 mg) - Cholesterol
    • Duoplavin (clopidogrel 75/aspirin 75 mg) - Antiplatelet medication, cardio-protective
    • Pantoprazole (40 mg) - Stomach tablet to reduce acid
    • Oxybutynin (10 mg daily) - Treats urge incontinence/urinary frequency
    • Aripiprazole (15 mg daily) - Antipsychotic medication
    • Telmisartan (40 mg daily) - Blood pressure/heart failure
    • Theophylline (200 mg twice a day) - Treats COPD
    • Sertraline (Lustral) (100 mg daily) - Antidepressant
    • Bisoprolol (1.25 mg daily) - Antihypertensive/heart failure/angina
    • Bumetanide (2 mg) - Diuretic used in heart failure
    • Detrusitol (tolterodine) (4 mg daily) - Urge incontinence/urinary frequency
    • Ventolin (salbutamol) "200" Diskus T inhalation (every 3.5 hrs) - Bronchodilator
    • Brimica genuair 340/12 (aclidinium/Formoterol) (one puff twice a day) - Inhaler for COPD
    • Ibuprofen (over-the-counter) - Pain relief

    7 Steps to Appropriate Polypharmacy

    • Step 1: What matters to the patient?
      • Identify patient's goals and priorities
      • Establish person-centered goals
    • Step 2: Is the medicine essential?
      • Review medications for essentiality
      • Ensure patient understands importance of essential medications
    • Step 3: Is it unnecessary or harmful?
      • Review medications for therapeutic goals and risk vs. benefit
      • Consider deprescribing unnecessary medications
    • Step 4: Is it cost-effective?
      • Review medications for cost-effectiveness
      • Explore opportunities for cost minimization
    • Step 5: Effectiveness
      • Review therapeutic objectives and medication effectiveness
      • Discuss and decide on adding, intensifying, or stopping medications
    • Step 6: Safety/harm
      • Identify safety risks and adverse drug reactions (ADRs)
      • Monitor for drug-disease interactions, drug-drug interactions, and high-risk drugs
    • Step 7: Agree plan with patient and communicate
      • Agree and communicate plan with patient and/or caregiver
      • Ensure patient understands outcome of review and administration instructions

    Appropriate and Inappropriate Polypharmacy

    • Appropriate polypharmacy: prescribing for an individual with complex conditions, optimized medication use, and evidence-based therapeutic objectives
    • Inappropriate polypharmacy: prescribing multiple medications inappropriately, or where intended benefits are not realized
    • The Scottish Polypharmacy Model of Care Group defines five stages for appropriate polypharmacy:
      1. Prescribing (and risk assessment)
      2. Medication review
      3. Dispensing and administration
      4. Communication and patient engagement
      5. Medication reconciliation (at care transitions)

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    Description

    This quiz covers the changes in pharmacokinetics and pharmacodynamics that occur with advanced age, affecting the body's handling of drugs and their actions on the body.

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