Term
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Definition
a dispropotionately high prescription drug use exists in the elderly
experience more adverse drug reactions and drug-drug interactions
altered pharmacokinetics
multiple and severe illnesses
multiple-drug therapy
poor adherence |
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Term
| altered pharmacokinetics in geriatric patients |
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Definition
| more sensitive to drugs than younger adults and have wider variation |
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Term
| what is multiple-drug therapy? |
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Definition
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Term
| treatment and geriatric patients |
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Definition
individualization of treatment is essential
each patient must be monitored for desired and adverse responses
regimen must be adhered to
goal of treatment is to reduce symptoms and improve quality of life |
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Term
| drug therapy in geriatric patients |
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Definition
pharmacokinetic changes
pharmacodynamic changes
adverse drug reactions and drug interactions
promoting adherence |
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Term
| pharmacokinetic processes in geriatric patients |
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Definition
absorption
distribution
metabolism
excretion |
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Term
| absorption in geriatric patients |
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Definition
altered GI absorption is not major factor to drug sensitivity
percentage of an oral dose that is absorbed does not change with age
rate of absorption may slow
delayed gastric emptying and reduced splanchnic blood flow occur |
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Term
| distribution in geriatric patients |
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Definition
increased percentage of body fat
decreased percentage of lean body mass
decreased total body water
reduced concentration of serum albumin |
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Term
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Definition
| storage depot for lipid-soluble drugs |
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Term
| total body water in geriatric patients |
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Definition
| distributed in smaller volume, thus concentration is increased and effects are more intense |
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Term
| explain the reduced concentration of serum albumin in geriatric patients |
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Definition
may be significatnly reduced in the malnourished
causes decreased protein binding of drugs and increase in levels of free drugs |
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Term
| metabolism in geriatric patients |
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Definition
hepatic metabolism declines with age
reduced hepatic blood flow, reduced liver mass, and decreased activity of some hepatic enzymes occur
half-life of some drugs may increase, and responses are prolonged
responses to oral drugs (first-pass effect) may be enhanced |
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Term
| excretion in geriatric patients |
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Definition
renal function undergoes progressive decline beginning in early adulthood
drug accumulation secondary to reduced renal excretion is the most important cause of adverse drug reactions in the elderly |
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Term
| what renal functions undergo progressive decline beginning in early adulthood |
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Definition
| reduction in renal blood flow, GFR, active tubular secretion, and number of nephrons |
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Term
| what drugs should you use in elderly patients to assist with excretion? |
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Definition
drugs that are eliminated primarily by the kidneys
creatine clearance, not serum creatine |
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Term
| pharmacodynamic changes in the elderly |
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Definition
| alterations in receptor properties may underlie altered sensitivity to some drugs |
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Term
| what drugs have more intense effects in the elderly? |
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Definition
warfarin
certain CNS depressants |
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Term
| beta blockers in the elderly |
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Definition
less effective in the elderly, even in the same concentrations
reduction in number of beta receptors
reduction in the affinity of beta receptors for beta-receptor blocking agents |
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Term
| adverse drug reactions in the elderly |
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Definition
7 times more likely
16% of hospital admissions
50% of all medication-related deaths
majority are dose related, not idiosyncratic
symptoms are often nonspecific like dizziness and cognitive impairment |
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Term
| predisposing ADR factors in the elderly |
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Definition
drug accumulation secondary to reduced renal function
polypharmacy
greater severity of illness
multiple pathologies
greater use of drugs that have a low therapeutic index(digoxin)
increased individual variation secondary to altered pharmacokinetics
inadequate supervision of long-term therapy
poor patient adherence |
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Term
| measures to reduce ADRs in the elderly |
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Definition
take thorough drug history, including OTCs
consider pharmacokinetic and dynamic changes due to age
monitor for clinical response/plasma drug levels
use the simplest regimen possible
monitor for drug-to-drug interactions
periodically review the need for continued drug therapy
encourage patient to dispose of old meds
take steps to promote adherence adn avoid drugs on the Beers List |
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Term
| promoting adherence with unintentional nonadherence in the elderly |
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Definition
simplified drug regimens
clear, concise verbal and written instructions
appropriate dosage form
clearly labeled and easy-to-open containers
daily reminders
support system
frequent monitoring |
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Term
| intentional nonadherence in the elderly |
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Definition
most cases (75%) of nonadherence are intentional
reasons include: expense, side effects, patient's conviction that the drug is unnecessary or the dosage too high |
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