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Geriatric Pharmacology

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Title: Geriatric Pharmacology Author: WWCC Last modified by: amallon Created Date: 3/6/2006 5:04:22 AM Document presentation format: On-screen Show – PowerPoint PPT presentation

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Title: Geriatric Pharmacology


1
Geriatric Pharmacology
  • Dr Andrew P Mallon

2
Adults gt65 years old
  • Fastest growing population in US
  • 20 of hospitalizations for those gt65 are due to
    medications theyre taking

3
Effects of Aging on Rx use(Absorption)
  • Reduced gastric acid production
  • Raises gastric pH
  • May alter solubility of some drugs (ASA etc)
  • Longer gastric emptying
  • Delay or reduce absorption
  • Decreased esophageal motility
  • Capsules more difficult to swallow
  • Loss of subcutaneous fat
  • Increased rate of absorption of topical
    medications
  • Increased fagility of veins
  • IV administration more difficult

4
Effects of Aging on Rx use(Distribution)
  • Decreased cardiac output/circulation changes
  • May delay onset or extend effect of medications
  • Decrease of lean body mass/increase of fatty
    tissue where medications are stored
  • Prolong medications action
  • Increase sensitivity
  • Increase toxic effects
  • Higher plasma levels/more erratic distribution

5
Effects of Aging on Rx use(Metabolism)
  • Difficult to predict, depends on
  • General health nutritional status
  • Use of alcohol, medications
  • Long term exposure to environmental
    toxins/pollutants
  • Aging causes decreased liver mass/ hepatic blood
    flow
  • Delayed/reduced metabolism of drugs
  • Higher plasma levels
  • Lower serum protein levels
  • Loss of protein binding
  • Idiosyncratic reactions

6
Effects of Aging on Rx use(Excretion)
  • Reduction in number of functioning
    nephrons/decreased glomerular filtration rate
  • Longer half-life of medications
  • Increased side effects
  • Increased potential for toxicity

7
  • A story Tom, age 68
  • Takes seven different medications
  • Cant remember which medication to take when, so
    takes them all at bedtime

8
Tom is typical of aging
  • Multiple medications to control multiple health
    problems
  • Age changes pharmacokinetics, so more vulnerable
    to
  • Adverse effects
  • Drug interactions (can rob them of therapeutic
    effects of medications theyre taking)

9
  • Functional impairments
  • Vision loss
  • Cognitive dysfunction
  • Musculoskeletal disorders

10
  • Sociocultural factors may make person
    unable/unwilling to follow prescribed medical
    regimen
  • Loss of family, friends, income
  • Limited/fixed income

11
  • Economic factors
  • May have to choose between food and medications
  • OTCs instead of expensive doctor visits
  • Use of outdated medications
  • Use of home remedies
  • Share medications
  • Nutritional status may affect how body
    metabolizes medications

12
Polypharmacy
  • Concurrent use of multiple medications
  • gt65 12 of population
  • Consume 30 of all prescription drugs average
    person takes 4-5 prescription meds
  • Consume 40 of OTCs
  • Excessive use of drugs
  • Overdose of a drug

13
Polypharmacy
  • Doctors more likely to prescribe medications for
    older clients than young ones
  • Altered response to medications cumulative
    effect on physiology of aged
  • Aging
  • Disease
  • Stress
  • Trauma

14
Polypharmacy
  • Elderly rely on various medication to control or
    relieve a range of age-related problems
  • Cardiovascular disease
  • Diabetes
  • Degenerative joint disease
  • Autoimmune disorders

15
Polypharmacy
  • Risks of problems
  • Medication errors
  • Wrong drug, time, route
  • Adverse effects from each drug
  • Polypharmacy primary reason for adverse reactions
  • Adverse interactions between drugs

16
Troublesome medications
  • Antacids
  • Acid-base imbalance (sodium bicarbonate)
  • Constipation (aluminum hydroxide)

17
Troublesome medications
  • Antiarrhythmics
  • Confusion
  • Slurred speech
  • Light-headedness, seizures
  • hypotension

18
Troublesome medications
  • Anticoagulants
  • bleeding

19
Troublesome medications
  • Antihistamines
  • Urinary difficulty
  • Short-term memory dysfunction
  • Drowsiness, dizziness

20
Troublesome medications
  • Antihypertensives
  • Dizziness and falls
  • Orthostatic hypotension

21
Troublesome medications
  • Antiparkinsons agents
  • Uncontrolled movements (grimacing, tongue
    movements, eyes rolling back, twisted neck)
  • Dark urine (levodopa)

22
Troublesome medications
  • Antipsychotics
  • Jaundice
  • Extrapyramidal symptoms
  • Sedation, dizziness (can lead to falls)
  • Orthostatic hypotension
  • Scaling skin on exposure to sunlight
    (phenothiazines)

23
Troublesome medications
  • Anxiolytics
  • Confusion, lethargy
  • Slurred speech
  • Ataxia, falls
  • Blurred vision

24
Troublesome medications
  • Corticosteriods
  • Sodium retention (may worsen HTN CHF)
  • Insomnia
  • Psychotic behavior
  • osteoporosis

25
Troublesome medications
  • Digitalis glycosides
  • Fatigue
  • Loss of appetite, nausea, vomiting
  • Visual disturbances
  • Nightmares, nervousness
  • Hallucinations
  • Bradycardia, arrhythmias

26
Troublesome medications
  • Diuretics
  • Fluid/electrolyte disorders
  • Dehydration
  • Hypotension
  • Thiazide diuretics can increase blood glucose
    levels (more insulin for diabetics)

27
Troublesome medications
  • Hypoglycemics and insulin (especially in people
    with reduced kidney function)
  • Hypoglycemia from missed meals, alcohol intake,
    increased exercise

28
Troublesome medications
  • Laxatives
  • Intestinal malabsorption
  • Reduced absorption of fat-soluble vitamins (if
    taking mineral oil)
  • Magnesium toxicity (clients with renal
    insufficiency taking magnesium)

29
Troublesome medications
  • Narcotic analgesics
  • Respiratory depression
  • Constipation
  • Urinary retention
  • Demerol
  • Hypotension, dizzines
  • confusion

30
Troublesome medications
  • NSAIDs
  • Prolong bleeding
  • Gastric discomfort, bleeding
  • Increased risk of toxicity (with impaired renal
    function)

31
Troublesome medications
  • Respiratory agents
  • Restlessness, nervousness
  • Confusion
  • Blood pressure disturbances
  • Palpitations, tachycardia
  • Chest pain

32
Troublesome medications
  • Tricyclic antidepressants
  • Dry mouth
  • Constipation
  • Blurred vision
  • Postural hypotension
  • Dizziness
  • Tachycardia
  • Urinary retention

33
If client taking gt five meds regularly
  • Suggest physician prescribe combination drugs or
    long-acting forms
  • Fewer pills to remember
  • Suggest re-evaluation of medications periodically
  • Encourage client to use one pharmacy
  • New medications
  • Good information
  • Encourage follow up

34
Medication aids
  • Remove cotton packing
  • Store in original container
  • Dry place
  • Away from heat/light
  • Follow dosing instructions
  • Get rid of outdated medications
  • Avoid sharing medications

35
Medication aids
  • For those with vision problems
  • Large print labels
  • Color coded labels

36
Medication aids
  • Nonchildproof caps
  • Memory aids
  • If taking antihypertensives
  • Get up slowly
  • Alternative, non-pharm or herb therapies
  • Massage
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