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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

Geriatric Pharmacology

Barbara S. Hays

Winter, 2006

adults 65 years old
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
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
effects of aging on rx use distribution
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
effects of aging on rx use metabolism
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
effects of aging on rx use excretion
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
slide7
A story: Tom, age 68
    • Takes seven different medications
    • Can’t remember which medication to take when, so takes them all at bedtime
tom is typical of aging
“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)
slide9
Functional impairments
    • Vision loss
    • Cognitive dysfunction
    • Musculoskeletal disorders
slide10
Sociocultural factors may make person unable/unwilling to follow prescribed medical regimen
      • Loss of family, friends, income
      • Limited/fixed income
slide11
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
polypharmacy
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
polypharmacy1
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
polypharmacy2
Polypharmacy
  • Elderly rely on various medication to control or relieve a range of age-related problems
    • Cardiovascular disease
    • Diabetes
    • Degenerative joint disease
    • Autoimmune disorders
polypharmacy3
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
troublesome medications
Troublesome medications
  • Antacids
    • Acid-base imbalance (sodium bicarbonate)
    • Constipation (aluminum hydroxide)
troublesome medications1
Troublesome medications
  • Antiarrhythmics
    • Confusion
    • Slurred speech
    • Light-headedness, seizures
    • hypotension
troublesome medications2
Troublesome medications
  • Anticoagulants
    • bleeding
troublesome medications3
Troublesome medications
  • Antihistamines
    • Urinary difficulty
    • Short-term memory dysfunction
    • Drowsiness, dizziness
troublesome medications4
Troublesome medications
  • Antihypertensives
    • Dizziness and falls
    • Orthostatic hypotension
troublesome medications5
Troublesome medications
  • Antiparkinson’s agents
    • Uncontrolled movements (grimacing, tongue movements, eyes rolling back, twisted neck)
    • Dark urine (levodopa)
troublesome medications6
Troublesome medications
  • Antipsychotics
    • Jaundice
    • Extrapyramidal symptoms
    • Sedation, dizziness (can lead to falls)
    • Orthostatic hypotension
    • Scaling skin on exposure to sunlight (phenothiazines)
troublesome medications7
Troublesome medications
  • Anxiolytics
    • Confusion, lethargy
    • Slurred speech
    • Ataxia, falls
    • Blurred vision
troublesome medications8
Troublesome medications
  • Corticosteriods
    • Sodium retention (may worsen HTN & CHF)
    • Insomnia
    • Psychotic behavior
    • osteoporosis
troublesome medications9
Troublesome medications
  • Digitalis glycosides
    • Fatigue
    • Loss of appetite, nausea, vomiting
    • Visual disturbances
    • Nightmares, nervousness
    • Hallucinations
    • Bradycardia, arrhythmias
troublesome medications10
Troublesome medications
  • Diuretics
    • Fluid/electrolyte disorders
    • Dehydration
    • Hypotension
    • Thiazide diuretics can increase blood glucose levels (more insulin for diabetics)
troublesome medications11
Troublesome medications
  • Hypoglycemics and insulin (especially in people with reduced kidney function)
    • Hypoglycemia from missed meals, alcohol intake, increased exercise
troublesome medications12
Troublesome medications
  • Laxatives
    • Intestinal malabsorption
    • Reduced absorption of fat-soluble vitamins (if taking mineral oil)
    • Magnesium toxicity (clients with renal insufficiency taking magnesium)
troublesome medications13
Troublesome medications
  • Narcotic analgesics
    • Respiratory depression
    • Constipation
    • Urinary retention
    • Demerol:
      • Hypotension, dizzines
      • confusion
troublesome medications14
Troublesome medications
  • NSAIDs
    • Prolong bleeding
      • Gastric discomfort, bleeding
    • Increased risk of toxicity (with impaired renal function)
troublesome medications15
Troublesome medications
  • Respiratory agents
    • Restlessness, nervousness
    • Confusion
    • Blood pressure disturbances
    • Palpitations, tachycardia
    • Chest pain
troublesome medications16
Troublesome medications
  • Tricyclic antidepressants
    • Dry mouth
    • Constipation
    • Blurred vision
    • Postural hypotension
    • Dizziness
    • Tachycardia
    • Urinary retention
if client taking five meds regularly
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
medication aids
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
medication aids1
Medication aids
  • For those with vision problems
    • Large print labels
    • Color coded labels
medication aids2
Medication aids
  • Nonchildproof caps
  • Memory aids
  • If taking antihypertensives
    • Get up slowly
  • Alternative, non-pharm [or herb] therapies
    • Massage