Drug Therapy in Geriatric patients

Question 1

Factors affecting medication complications in elderly

Answer 1

1. Alterations in PK
2. Multiple and severe illnesses
3. Multidrug therapy
4. Poor adherence

Question 2

PK changes in elderly

Answer 2

1. absorption: extent not really effected but rate is - can lead to delayed response
2. distribution: numerous alterations
3. Metabolism: difficult to predict how this is effected patient to patient
4. Excretion: drug accumulation secondary to reduced renal excretion is the most important cause of adverse drug reactions in the elderly

Question 3

Absorption changes in elderly

Answer 3

Decreased GI motility, gastric emptying, intestinal CYP450, and intestinal Pgp activity

Question 4

Distribution changes in elderly

Answer 4

Decreased albumin, lean body mass and total body water, pgp expression and activity, and INCREASED relative body fat

Question 5

Metabolism changes in elderly

Answer 5

Decrease albumin, hepatic blood flow, hepatic metabolism, and INCREASED a 1 acid glycoprotein

Question 6

Excretion changes in elderly

Answer 6

Decrease biliary excretion and renal function

Question 7

PD changes in elderly

Answer 7

-may have significant alterations in receptor activity but is difficult to predict (reduction in number of receptors, reduction in receptor affinity)

Question 8

Adverse Drug reactions and interactions in elderly

Answer 8

1. 7 times more common in the elderly vs young patients
2. Accounts for about 16% hospital admission in older patients and 50% of all medication related deaths
3. Why?: drug accumulation, polypharmacy, greater severity of illness, multiple pathologies, greater use of NTI drugs, alterations in PK, inadequate supervision of long term therapy, and poor adherence