What are some of the characteristics that we should be aware of when treating the elderly?
- primary consumers of healthcare services
- numerous chronic health conditions
- multiple and complex dosing regimens
- difference in ADME
- drug interaction is higher likely
- difficulty in self administration
- specialty medications for the elderly
What are some of the diseases to be more conscious of in the elderly?
- coronary heart disease, cancer, alzheimer’s disease, strokes, arthritis, osteoporosis
ADME ____ due to aging
decreases
What are some of the reasons by ADME is decreased in the geriatric populations?
- health conditions are highly variable among geriatric populations
- drug interaction/accumulation/AE prevalent due to multiple regimens
- mechanisms poorly studies/understood due to limited subject population
- dose adjustment not strongly recommended
What are some of the GI factors that decrease the absorption time?
- decreases intestinal blood flow
- increase gastric pH
- decrease active drug absorption
- decrease gastic emptying time
(can possibly improve via formulation manipulation)
Why do we want to avoid multi-dose liquids in the elderly?
- can cause spilling, there can be a lack of control over their fine motor skills
What factors alter the distribution factor in the elderly?
- decreased CO
- increase in fat and lea body mass
- decreased serum albumin concentration
- decreased drug reaching the tissues
What is the difference in the volume of distribution of drugs in the elderly?
- decreased Vd in water soluble drugs
- increased Vd in lipid-soluble drugs
- increased prevalence of protein bound drugs
What are the factors that alter the metabolism process in the elderly?
- decreased hepatic blood flow
- decreased liver size
- decreased phase 1 metabolism
- increased incidence of liver dysfunction
What is the effect of altered metabolism on the drugs in the body?
- half life of hepatically extracted drugs increases
- increased drug accumulation
- increased pharmacological synergy
What are the factors that lead to an altered elimination rate in the elderly?
- decreased renal blood flow
- decreased glomerular filtration rate
- decreased active renal tubular secretion
- decreased number of functioning nephrons
What is the effect of altered elimination in the body?
- half life of really excreted drugs increases
- increased drug accumulation
- increased pharmacological synergy
Baroreceptor reflex in elderly _____
decreases
B1 receptor response ____ in elderly
decreases
Alpha2 receptor response ____ in the elderly
decreases
Glucose tolerance test ____ in the elderly
decreases
Sensitivity to barbiturates ____ in the elderly
increases
What is a common effect of taking antihypertensives in the elderly?
- prone to accidental falls
The effects of beta blockers ____ in the elderly
decreases
What is the purpose of coated tablets and why do elderly typically need them?
- the idea is to minimize sticking to the mucosal membranes in the back of the throat
- elderly often have decreased saliva, so normal tablets stick to the back of the throat
What is the absorption effect of transdermal patches in the elderly?
- decreased absorption of transdermal patches in the elderly - their stratum corneum is still there, but there is a lack of moisture to allow for the dissolution of the drug before it goes across the skin
- decreased water content is the limiting factor that is affecting the movement of the drug across the skin
What changes happen to the oral mucous in the elderly?
- drier, increases susceptibility to injury, decreased capillary blood supply
What changes happen to the oral muscles in the elderly?
decreased bulk and tone, decreased masticatory efficiency
What changes happen to the salivary glands in the elderly?
- decreased resting secretory rate, increased viscosity of saliva, decreased enzyme activity of saliva
