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7/21/2019 Principles of Drug Therapy for the Elderly Patient
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Principles of Drug Therapyfor the Elderly.
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$actors That nterfere )ith &afe and&uccessful Drug Therapy in the Elderly
*arriers to the recognition of the need to obtain care(cultural economic physical psychological%
Atypical presentation of illness
+ultiple illnesses Dementia.
Diminish vision or hearing
mpairment to compliance (cultural economicphysical physiologic%
Polypharmacy
ncreased susceptibility to adverse drug events.
Age,related change in pharmacology (AD+E%
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nappropriate Polypharmacy in theElderly:
Polypharmacy may be inappropriate ifmore drugs are prescribed thannecessary prescription of drugs )ith
unacceptable side effects co,prescriptionof drugs )ith harmful drug,drug anddrug,disease interactions.
A ma-or concern about polypharmacy isthe potential for adverse drug reactionsand interactions.
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nappropriate Polypharmacy in theElderly
on,adherence increased ris! ofhospitalizations medication errorsand increased cost resulting fromtreatment of adverse events or otherpotential problems )ith inappropriatepolypharmacy.
As the number of medications used bypatient increases the incidence ofAD/s increases e'ponentially
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nappropriate Polypharmacy in theElderly
The potential for an AD/ is estimated at 01)hen 2 drugs are ta!en at 341 )hen 3 drugsare ta!en and at nearly 5441 )hen 6 or moredrug are ta!en.
The ris! of a serious AD/ also increases )ithage7 it is 56.31 in adults aged 33,08 years94.51 in those 3,68 and 85.6 in those 63and older.
Physicians may contribute to polypharmacy bye'cessive or inappropriate prescribing practiceor through lac! !no)ledge about drug actionsand interactions.
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Effects of Aging onPharmaco!inetics:
Absorption:
, ; motility and blood flo) decrease7 drugabsorption rate decreases p# decreases
intestinal motility decreases. Therefore drugabsorption is <uantitatively unaffected by aging
Distribution:
, =d of )ater soluble drugs decreases7 loading
dose should be decreased., =d of fat soluble drugs increases7 t5>2 increases.
, $ree drug concentration in plasma increases.
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Effects of Aging onPharmaco!inetics:
+etabolism:, Phase drug metabolism declines7 liver size
and hepatic blood flo) decrease. Dosage ofhepatically metabolized drugs should be
reduced in elderlyE'cretion:, #alf,life of drugs undergoing renal elimination
prolongs7 the daily dose should be based oncreatinine clearance. The follo)ing formula is
useful in estimating "?cr: "?cr@(584,Age%'*>2'"r.
4.63 is a correction factor for )omen.
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Effects of Aging onPharmacodynamics
#omeostatic control mechanisms areblunted response to drugs may change theintensity of response.
$or e'ample blood pressure goes up )ithage but the incidence of orthostatichypotension also increase mar!edly.
Polypharmacy is associated )ith an
increased fall ris!. Bse of diureticshypnotic,sedatives 5st antihistaminesanticholinergics is associated )ithincreased falling.
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Principles of ;eriatricPrescribing
Evaluate the need for drug therapy. Ta!e a careful history of habits and drug use. Cno) the pharmacology of drug prescribed.
*egin therapy )ith small doses. Titrate the dosage )ith patient response. &implify the regimen and encourage
compliance. /egularly revie) the treatment plan
discontinue drugs no longer needed. /emember that drugs may cause ne)
problems or e'acerbate chronic problems.
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54 &teps to Prudent Bse of Drugsin the Elderly:
Disclosing all medications. dentifying drugs by generic name and class. Bsing the right drug for the right indication. Cno)ing the side effect profile of the drug being
prescribed. Bnderstand ho) drug !inetics and dynamics increase
the ris! of ADE &top any drug )ithout !no)n benefit. &top any drug )ithout a clinical indication.
Attempt to substitute a less to'ic drug. *e a)are of prescribing cascade. As much as possible use the motto one disease
one drug once,a,day.
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"ommon Drugs )ith AdverseEvents in the Elderly
&ADs
Aminoglycosides.
Anticholinergics
Anticoagulants
Antidepressants
Antipsychotics
*eta bloc!ers Digo'in
nsulin AD
arcotics
&edative hypnotics
+uscle rela'ants
5st antihistamines
+ethyldopa and
reserpine. egativeFinotropic
antiarrythmias
