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Geriatric Pharmacology

Geriatric Pharmacology. Barbara S. Hays Winter, 2006. Adults >65 years old. Fastest growing population in US 20% of hospitalizations for those >65 are due to medications they’re taking. Effects of Aging on Rx use (Absorption). Reduced gastric acid production Raises gastric pH

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Geriatric Pharmacology

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  1. Geriatric Pharmacology Barbara S. Hays Winter, 2006

  2. Adults >65 years old • Fastest growing population in US • 20% of hospitalizations for those >65 are due to medications they’re 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 medication’s 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 • Can’t 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 they’re 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 • >65 = 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 • Antiparkinson’s 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 > 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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