10 questions of commom medications in elderly

1. 1. When we use only the clinical improvement and serum T4 (not TSH) to
estimate the appropriate replacement dose of levothyroxine?
2. Your way to manage myxedema coma using 3 drugs?
3. Early goal-directed therapy (EGDT) to optimize oxygen delivery in septic
Shock??(4 interventions)
4. Administration of bisphosphonate (prophylaxis, treatment) routes, doses
5. Anti-emetics (best choice in elderly)
6. Drugs for pain control, mention step approach and side effects
7. Intra venous antiplatelets
8. Drugs used in dementia mechanisms and generic names
9. Different members and mechanisms antiaggregant?
10.Famous Drug interactions of warfarin??

2. 1. When we use only the clinical improvement and serum T4 (not TSH) to
estimate the appropriate replacement dose of levothyroxine?
Central hypothyroidism (e.g. hypothalamic/pituitary disorders)
2. Your way to manage myxedema coma using 3 drugs?
a. 300- 500 mcg LT4 levothyroxine intravenously initially, and is
followed by a daily intravenous dose of 50-100.
b. hydrocortisone 50 to 100 mg every 6 hours,
c. T3 Liothyronine 5-20 micrograms intravenously and to be continued
at a dosage of 2.5-10 micrograms every 8 hours.
3. Early goal-directed therapy (EGDT) to optimize oxygen delivery in
septic Shock??(4 interventions)
a. Fluids CVP of < 8 mm Hg Administer 30 mL/kg Crystalloid
persistent arterial hypotension despite volume resuscitation (septic
shock) or lactate ≥ 36 mg/dL
b. Vasopressors CVP of at least 8 to 12 mm Hg Norepinephrine is
recommended as first choice vasopressor
c. inotropic agents, a trial of dobutamine infusion up to 20 μg/kg/min
added to vasopressor if myocardial dysfunction or ongoing signs of
hypoperfusion, despite achieving adequate intravascular volume and
adequate MAP
d. red blood cell transfusion occur only when hemoglobin concentration
decreases to < 7 target a hemoglobin level of 7 to 9 g/dL
4. Administration of bisphosphonate (prophylaxis, treatment) routes,
doses
Avoid when CrCl < 35 mL/min
a. Oral
 Take after an overnight fast with (180–240 mL) plain water
while sitting or standing upright at least 30 minutes prior to
morning meal
 Do not lie down for 30 minutes after administration.
 Do not take with other medications or fluids.
 Do not chew or suck on the tablet

3. i. Alendronate Prevention of PM osteoporosis: 5 mg orally daily
or 35 mg orally once weekly therapeutic: Osteoporosis (men
and women): 10 mg orally once daily or 70 mg orally once
weekly
ii. Ibandronate Treatment or prevention of PM osteoporosis: 2.5
mg orally daily or 150 mg orally once monthly; 3 mg IV push
over 15–30 seconds every 3 months
iii. Risedronate : PM osteoporosis: 5 mg orally daily, 35 mg orally
once weekly, 75 mg on 2 consecutive days each month, or 150
mg once monthly
 Iv therapeutic: Not to be administered with calcium infusions.
i. Zoledronate Dilute dose with 100mls of saline, or g5% and
infuse over 15minutes Prevention of PM osteoporosis: 5 mg
every 24 months Treatment 5 mg every 12 months
ii. Pamidronate IV90mg every 4 weeks , 90mg in 500mls saline,
g5% at rate of 1mg/minute,
iv. Ibandronate 3 mg IV push over 15–30 seconds every 3 months
5. Anti-emetics (best choice in elderly)
i. Anticholinergics, Antihistamines for vestibular mediated
(badfor elderly)
ii. Phenothiazines sedating confusion, respiratory depression,
extrapyramidal symptoms, and anticholinergic effects
iii. Domperidone Sedation, restlessness, diarrhea, agitation, CNS
depressionneuroleptic syndrome, supraventricular
tachycardia,QT prolongation, serotonin syndrome
iv. Metoclopramide causes acute extrapyramidal symptoms
v. Serotonin Antagonists Granisetron, Ondansetron QT
prolongation considered potentially safe in elderly
vi. Corticosteroids as antiemetics in chemotherapy-induced emesis
6. Drugs for pain control, mention step approach and side effects
Step 1: Non opioid (+ or-) adjuvant.(VAS 2- 4).
Step 2: Weak opioid (+) Non opioid (+ or-) adjuvant(VAS 4-
6).

4. Step 3: Strong opioid (+) Non opioid (+ or- )
adjuvant(VAS>6/10).
Step 4: Anesthetic/Neurosurgical Interventions.
Adjuvant medications
 Antidepressants.
 Anticonvulsants.
 Neuroleptic agents.
 Corticosteroids.
 Osteoclast inhibiting medications.
Analgesic:
 Paracetamol: risk of overdose, toxicity in hepatic
 NSAIDs:Increased risk of GI and renal complications in
elderly
 Selective COX-2 inhibitors: Similar nongastrointestinal
side effects to nonselective NSAIDs
 Opioid analgesics:
1. drowsiness
2. nausea and vomiting
3. constipation
4. Drug dependence is uncommon in elderly people
7. Intra venous antiplatelets:
i. Glycoprotein IIB/IIIA inhibitors
 Abciximab
 Eptifibatide
 Tirofiban
ii. frequently used during percutaneous coronary
intervention (angioplasty with or without intracoronary stent
placement
8. Drugs used in dementia mechanisms and generic names
i. Choline esterase inhibitors Donepezil Galantamine
Rivastigmine
ii. Anti-NMDA blockers Memantine
iii. Antioxidants Vitamin E, Ginkgo biloba
iv. Anti-Inflammatory Drugs

5. 9. Different members and mechanisms antiaggregant?
i. Irreversible cyclooxygenase inhibitors
 Aspirin
ii. Adenosine diphosphate (ADP) receptor inhibitors
 Clopidogrel, Ticlopidine
iii. Phosphodiesterase inhibitors
 Cilostazol
iv. Glycoprotein IIB/IIIA inhibitors (intravenous use only)
v. Adenosine reuptake inhibitors
 Dipyridamole
10.Famous Drug interactions of warfarin??
i. Increase Anticoagulation Effect
a. Acetaminophen
b. Amiodarone
c. Cephalosporins
d. Ciprofloxacin
e. Fenofibrate
f. Fluconazole
g. Influenza vaccine
h. Lovastatin
i. Metronidazole
j. Miconazole
k. Omeprazole
ii. Decrease Anticoagulation Effect
a. Carbamazepine
b. Cholestyramine
c. Phenytoin
d. Rifampin
e. Sucralfate
f. Vitamin K
iii. Increase Bleeding Risk
a. Argatroban
b. Aspirin
c. Clopidogrel
d. Dipyridamole
e. LMWHs
f. Nonsteroidal anti-inflammatory drugs
g. UFH