Questions and Answers
What is a common result of anticholinergic drugs on the central nervous system in older adults?
What effect can anticholinergic drugs have on older men with benign prostatic hyperplasia?
Which of the following is NOT a potential adverse effect of anticholinergic medications?
What strategy is generally recommended for older adults regarding the use of anticholinergic medications?
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Which of the following drugs is likely to have anticholinergic effects?
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What is one of the common risks associated with polypharmacy that could lead to hospitalization?
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How does polypharmacy contribute to economic burdens in healthcare?
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Which strategy is essential for managing polypharmacy in older adults?
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Which of the following is considered a potentially inappropriate medication in older adults?
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What is a common effect of anticholinergic medications that poses a risk in older adults?
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Study Notes
Drug-Receptor Interaction and Older Adults
- Variability in drug effects may arise from drug-receptor interactions, post-receptor events, and adaptive homeostatic responses.
- Frail patients may experience pathological organ changes affecting drug efficacy.
Sensitivity to Anticholinergic Drugs
- Older adults, especially with cognitive impairment, are more sensitive to anticholinergic drugs.
- Common anticholinergic medications include:
- Tricyclic antidepressants
- Sedating antihistamines
- Muscarinic agents for urinary symptoms
- Certain antipsychotics and antiparkinsonian drugs with atropine-like activity
- Over-the-counter hypnotics and cold preparations
- Adverse effects often include CNS issues like confusion and sedation, as well as:
- Constipation
- Urinary retention, notably in older men with benign prostatic hyperplasia
- Blurred vision
- Orthostatic hypotension
- Dry mouth
- Increased risk of heatstroke due to inhibited sweating
Risks of Antipsychotics
- Antipsychotics can lead to:
- Cognitive impairment
- Sedation
- Cardiac arrhythmias
- Parkinsonism
- Increased stroke and heart attack risk
- Osteoporosis
- Regular review is necessary for mental health prescriptions; avoid antipsychotics for behavioral disturbances in dementia patients.
Consequences of Polypharmacy
- Common consequences include:
- Adverse Drug Reactions (ADR)
- Drug interactions
- Noncompliance and reduced adherence
- Diminished functional status
- Geriatric syndromes
- Heightened hospitalization risk and potential mortality
- Adverse Drug Events (ADEs) are caused by medication errors, overdose, allergic reactions, and ADRs.
- ADEs are categorized into predictable events (related to normal pharmacokinetics) and unpredictable events (e.g., anaphylaxis).
Most Common Drug Side Effects
- Frequent side effects observed are:
- Sedation
- Nephrotoxicity
- Hepatotoxicity
- Cardiotoxicity
- Confusion and dizziness
- Hypotension
- Hypoglycemia
- ADRs cause approximately 10% of emergency room visits, affecting both outpatients (35%) and hospitalized elderly (44%).
Age-related Changes in Pharmacodynamics
- Various drugs show distinct pharmacodynamic responses with aging, such as:
- Diazepam: Increased sedation and postural sway
- Diltiazem: Increased antihypertensive effect
- Morphine: Enhanced analgesic effect
- Scopolamine: Decreased cognitive function
Risk Factors for Polypharmacy
- Individual risk factors include increased age, white race, and educational status contributing to polypharmacy in the elderly.
- Often identified risk factors can be classified as related to the individual or healthcare provider (General Practitioner).
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Description
This quiz explores the challenges of pharmacodynamics and pharmacokinetics in older adults, particularly in those with cognitive impairment. It covers how drug-receptor interactions and homeostatic responses can affect treatment outcomes. Test your knowledge on the implications of anticholinergic drugs and their effects on frail patients.
