05 - References

References

Prescribing in older people CHAPTER 6 Changes in the way these drugs are handled in older people and the greater chance of interaction with other drugs mean that toxicity and therapeutic failure are more likely. These drugs can be used safely but extra care must be taken and blood concentrations should be measured where possible. Some drugs inhibit or induce hepatic metabolising enzymes. Important examples include some SSRIs, erythromycin and carbamazepine. This may lead to the metabolism of another drug being altered. Many drug interactions occur through this mechanism. Details of individual interactions and their consequences can be found in the British National Formulary (BNF) online for individual drugs.12 Most can be predicted by a sound knowledge of pharmacology. Administering medicines in foodstuffs13–16 Sometimes patients refuse treatment with medicines, even when such treatment is thought to be in their best interests. In the UK, where the patient has a mental illness or has capacity, the Mental Health Act should be used, but if the patient lacks capacity this option may not be desirable. Medicines should never be administered covertly to older patients with dementia without a full discussion with the multidisciplinary team (MDT) and the patient’s relatives. The outcome of this discussion should be clearly documented in the patient’s clinical notes. Medicines should be administered covertly only if the clear and express purpose is to reduce suffering for the patient. (For further information, see ‘Covert administration of medicines within food and drink’ later in this chapter.) For advice on dosing of psychotropics in older people, see ‘A guide to medication doses of commonly used psychotropics in older adults’ later in this chapter. References

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16. Specialist Pharmacy Service. Covert administration of medicines in adults: pharmaceutical issues 2022 (last updated June 2023); https://www.sps. nhs.uk/articles/covert-­administration-­of-­medicines-­in-­adults-­pharmaceutical-­issues/.