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PHARMACOLOGY IN THE ELDERLY

PHARMACOLOGY IN THE ELDERLY. REFERENCES: Merck Manual Table 4 Drug-Disease Interactions in the Elderly IER NPTE Reviewer by O’Sullivan and Siegelman 2008 Pharmacology in Rehabilitation 4 th ed by Ciccone. POSE SPECIAL RISKS FOR ELDERLY PATIENTS Analgesics Anticoagulants

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PHARMACOLOGY IN THE ELDERLY

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  1. PHARMACOLOGY IN THE ELDERLY REFERENCES: Merck Manual Table 4 Drug-Disease Interactions in the Elderly IER NPTE Reviewer by O’Sullivan and Siegelman 2008 Pharmacology in Rehabilitation 4thed by Ciccone

  2. POSE SPECIAL RISKS FOR ELDERLY PATIENTS Analgesics Anticoagulants Antihypertensives, Antiparkinsonian drugs Diuretics hypoglycemic drugs psychoactive drugs

  3. Risk of upper GI bleeding - NSAIDs w aspirin ASPILET BUFFERIN ECOTRIN GENACOTE or other antiplatelet drugs (clopidogrelPLAVIX). NSAIDs - increase risk of cardiovascular events and can cause fluid retention and, rarely, nephropathy; can also increase BP

  4. COX 2 inhibitors (coxibs) – w risk of GI bleeding, especially in patients taking warfarinCOUMADINor aspirin ASPILET ECOTRIN GENACOTE (even at low dose) and in those w GI events.

  5. Anticoagulants- risk of bleeding • warfarinCOUMADIN (Careful dosing and monitoring impt.) • Antiparkinsonian drugs - risk of orthostatic hypotension and confusion • Levodopa • Because elderly patients with parkinsonism may be cognitively impaired, anticholinergic drugs should be avoided

  6. Antihyperglycemics - risk of hypoglycemia due to sulfonylureas • Chlorpropamide • Psychoactive drugs - risk of tardive dyskinesia, sedation, orthostatic hypotension, anticholinergic effects, and akathisia (subjective motor restlessness) • Longer-acting benzodiazepines (eg, clonazepamKLONOPIN, diazepam VALIUM, flurazepamDALMANE) should be avoided

  7. Antihistamines (eg, diphenhydramineBENADRYL NYTOL, hydroxyzineITERAX, VISTARIL) are not recommended as anxiolytics or hypnotics because of its anticholinergic effects.

  8. Of antidepressants, SSRIs and mixed serotonin/ dopamine INTROPINreuptake inhibitors are preferred than tricyclic antidepressants

  9. Common Adverse Effects Of Drugs In The Elderly (source: IER NPTE Reviewer 2008, Chapter 8: GERIATRIC PHYSICAL THERAPY by Susan B. O'Sullivan) (1) Confusion/dementia: tranquilizers, barbiturates, digitalis, antihypertensives, anticholinergic drugs; analgesics, antiparkinsonians, diuretics, beta-blockers. (2) Sedation/immobility: e.g., psychotropic drugs, narcotic analgesics. (3) Weakness: e.g., antihypertensives, vasodilator, digitalis, diuretics, oral hypoglycemics.

  10. (4) Postural hypotension: antihypertensives, diuretics, tricyclic antidepressants, tranquilizers, nitrates, narcotic analgesics. (5) Depression: antihypertensives, antiinflammatory, antimycobacterial, antiparkinsonians, diuretics, H2 receptor antagonists, sedative-hypnotics, vasodilators.

  11. (6) Drug induced movement disorders. • (a) Dyskinesias (involuntary, stereotypic and repetitive movements, i.e., lip smacking, hand movements, etc.) associated with long-term use of neuroleptic drugs and anticholinergic drugs, Levodopa. • (b) Akathisia (motor restlessness) associated with antipsychotic drugs. • (c) Essential tremor associated with tricyclic antidepressants, adrenergic drugs. • (d) Parkinsonism: associated with antipsychotics, sympatholytics. • (7) Incontinence: caused by or exacerbated by a variety of drugs, e.g., barbiturates, benzodiazepines, antipsychotic drugs, anticholinergic drugs.

  12. Anticholinergic side effects include confusion, sedation, delirium, dry mouth, constipation, urinary retention, blurred vision, and worsening of narrow angle glaucoma-- reasons why patients are predisposed to falls and fractures.

  13. THE END

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