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Drug Dosing: Geriatric Patients

Drug Dosing: Geriatric Patients

Elderly individuals encompass a diverse population with varying degrees of age-related physiological changes. Defining the elderly presents challenges, as the geriatric population is often arbitrarily categorized as individuals older than 65. However, many individuals in this group lead active and healthy lives, with an increasing number surpassing 85 years and falling into the older elderly category. Physiological changes associated with aging impact performance capacity and homeostatic...

Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Absorption

Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Absorption

As individuals age, their body's physiology evolves, affecting drug pharmacokinetics. The most apparent changes occur in the gastrointestinal tract, where an increase in gastric pH, a delay in gastric emptying, and a reduction in gastrointestinal motility are observed. Remarkably, these changes do not substantially modify the absorption of orally administered drugs, particularly those absorbed via passive diffusion.Transdermal drug delivery emerges as a highly viable method for older adults due...

Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Distribution

Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Distribution

Drug distribution in the human body is influenced by several factors, including plasma protein concentration, body composition, blood flow, tissue-protein concentration, and tissue fluid pH. Among these, changes in plasma protein concentration and body composition due to aging significantly affect how drugs are distributed within the body. Specifically, aging is associated with a decrease in albumin levels by about 10% and an increase in α1-acid glycoprotein levels. These alterations are not...

Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Metabolism

Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Metabolism

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Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Excretion

In geriatric patients, renal physiology undergoes significant changes, including diminished renal blood flow and a lower glomerular filtration rate (GFR), leading to alterations in medication clearance. Drugs such as aminoglycoside antibiotics, lithium, and digoxin, which rely on glomerular filtration for removal from the body, particularly impact pharmacokinetics. These drugs tend to have slower clearance rates in older adults, necessitating careful dosage considerations.Evaluation of renal...

Pharmacodynamics in Geriatric Patients: Effects of Age

Pharmacodynamics in Geriatric Patients: Effects of Age

Age-related pharmacokinetic changes are extensively documented, but understanding age-related pharmacodynamic alterations is relatively limited. This knowledge gap can be partly attributed to the complexity of developing appropriate measures of drug responses compared to bioanalytical methods for determining drug concentrations.Most information regarding age-related differences in human pharmacodynamics originates from cross-sectional studies. However, these studies assume that observed mean...

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Cardiovascular drug therapy in the elderly.

W S Aronow¹, W H Frishman, A Cheng-Lai

¹Department of Geriatrics and Adult Development, Mt. Sinai Medical School, New York, NY, USA.

Heart Disease (Hagerstown, Md.)

|December 1, 2001

Summary

Cardiovascular drug prescribing for older adults requires careful consideration due to age-related physiological changes and polypharmacy. Special attention is needed for drugs like digoxin, lidocaine, and warfarin to prevent toxicity and drug interactions.

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Area of Science:

Geriatrics
Cardiology
Pharmacology

Background:

Cardiovascular diseases are highly prevalent in the elderly population.
Aging significantly impacts drug absorption, distribution, metabolism, and excretion.
Older patients frequently use multiple medications, increasing the risk of drug interactions.

Purpose of the Study:

To highlight pharmacologic issues in elderly cardiovascular drug therapy.
To provide recommendations for safe prescribing of cardiac drugs in older patients.

Main Methods:

Review of age-related pharmacokinetic and pharmacodynamic changes.
Identification of high-risk cardiovascular drugs for the elderly.
Analysis of potential drug-drug interactions in geriatric patients.

Main Results:

Age-related changes necessitate dosage adjustments for many cardiovascular drugs.
Drugs such as digoxin, lidocaine, and warfarin pose a higher toxicity risk in older adults.
Polypharmacy significantly elevates the risk of adverse drug events and interactions.

Conclusions:

Safe prescribing of cardiac drugs in the elderly demands a thorough understanding of aging effects on drug response.
Careful medication review and monitoring are crucial to mitigate risks associated with cardiovascular pharmacotherapy in geriatric patients.