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CHAPTER 3

CHAPTER 3. Geriatric Pharmacology. Drug Use in the Elderly. Modern drugs have made a significant contribution to extension of life span Older population accounts for highest percentage of drug usage With onset of chronic diseases, the geriatric population averages 3 to 4 drugs per individual

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CHAPTER 3

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  1. CHAPTER 3 Geriatric Pharmacology

  2. Drug Use in the Elderly • Modern drugs have made a significant contribution to extension of life span • Older population accounts for highest percentage of drug usage • With onset of chronic diseases, the geriatric population averages 3 to 4 drugs per individual • There is a high potential for adverse drug reactions and drug-drug interactions when multiple drug combinations are administered

  3. Drug use by elderly • Fastest growing segment of population • In last 50 years: dramatic increase in – • Understanding of disease • Diagnostic methods • Hence – Highest % of drug prescriptions • Elderly average 3-4 drugs/person • Egg. HBP, arthritis, COPD, CHF  • 10 or more drugs / day - Polypharmacy

  4. How are elderly different • 1. ↓ total body water, albumen and muscle mass • 2.  fat • 3. subject to confusion and falls • 4. ↓liver function – DMMS (drug microsomal metabolizing system) hence – drug action prolonged • 5. ↓renal blood flow - ↓drug excretion

  5. How are elderly different • 6. Interaction with other diseases P. 34 • 7. drug compliance – explain- why take it • Don’t buy it !! • Don’t understand how to take it - talk English ! • Take it QOD – “ yes doc – I'm taking it” • Cant get the lid off • TID or Q6H hard to do - try for QD or BID • Confusion or misunderstanding

  6. Effects of Aging on Drug Absorption and Distribution • Decreased intestinal blood flow, surface area, and motility delay drug absorption and slow the onset of drug action • Decreased body water, lean body mass, and plasma proteins along with increased fat content tend to increase plasma drug concentrations and pharmacologic effects

  7. Effects of Aging on Drug Metabolism and Elimination • Decreased liver blood flow, liver organ function, and amounts of oxidative enzymes slow drug metabolism and increase the duration and intensity of drug action • Age-related decreases in renal function and blood flow slow the rate of drug elimination and increase the duration and intensity of drug action

  8. Other Factors That Increase Drug Response in the Aged • General decline in health and nutrition • Presence of chronic diseases such as heart disease, high blood pressure, arthritis, diabetes, and cancer • Deterioration of memory, changes in mental status, and use of other drugs (hypnotics, antidepressants, etc.) can lead to confusion, forgetfulness, and drug noncompliance – automatism!

  9. Drug Compliance • Dosage forms and drug vials must be easy to use • Instructions must be clear and easy to read • Specific times and routine for drug dosing must be established • Patience and a positive attitude by care-givers is very important

  10. Problems in dosing Chapter 4 • 1. Conversion tables - P43 - apothecary units weights and volumes • 2. Practice problems P 44 • 3. take home test Chapter Review P 48-49 - due next class

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