Vulnerable population

Question 1

Older patients.

Answer 1

• Cognitive effects of anticholinergic
• increase risk of SIADH during treatment with SSRI and some anticonvulsants like (oxcarb)
• increase risk of orthstatis hypotension with alpha adrenergic blocking agents.
• potential for diinhibition with use of benzos.
• excessive somnolence from antihistaminic agent and other sedatives.

Question 2

Dosing considerations for psychotropic drug use in the geriatric population

Atomoxetine

buspirone

Carbamazepine
Divalproex
Gabapentin
Lamictal
Trileptal

Answer 2

Atomoxetine-none
Buspirone-no special dosing recommendation, although known renal insufficiency can increase plasma half-life.
Carbamazepine-no studies/dosing recommendations.
Divalproex:-Reduce starting dose and more gradual dose increase. Monitor for somnolence.
Gabapentin-dose it selection should be cautious, usually starting at the low end of the dosing range. Higher incidence of peripheral edema and ataxia found in older adults.
Lamictal-no formal study in elderly. MFL recommends dosage initiated at the low dose of the dosing range due to the potential for decreased hepatic, renal or cardiac function in older adults.
Trileptal-observed increases in plasma levels along more than 60 age are attributed to decreased CrCL. There are otherwise no formal recommendations.

Question 3

Dosing considerations for psychotropic drug use in the geriatric population