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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 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...

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...

Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Metabolism

Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Metabolism

Geriatric patients show significant variation in how their bodies process medications, which can change how effective and safe treatments are. The liver is the primary organ where drug metabolism occurs, involving two main types of chemical reactions: phase I and II. Phase I metabolism is driven by the cytochrome P450 enzyme system, which includes key types such as CYP3A, CYP2D6, and CYP2C9. Research indicates that while aging doesn't notably alter the levels or activity of these enzymes, it...

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 Excretion

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...

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Cardiovascular drug therapy in the elderly.

Wilbert S Aronow¹, William H Frishman, Angela Cheng-Lai

¹Department of Medicine, New York Medical College/Westchester Medical Center, Valhalla, New York 10595, USA. wsaronow@aol.com

Cardiology in Review

|June 19, 2007

Summary

Physiologic changes in elderly patients alter drug absorption, metabolism, and response. This review covers cardiovascular drug use, adverse effects, and best practices for safe medication management in older adults.

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Area of Science:

Gerontology
Clinical Pharmacology
Cardiology

Background:

Aging alters physiological processes impacting drug pharmacokinetics and pharmacodynamics.
Older adults experience changes in drug absorption, distribution, metabolism, and excretion.
Altered end-organ responsiveness in the elderly affects drug efficacy and safety.

Purpose of the Study:

To review pharmacokinetic and pharmacodynamic considerations for cardiovascular drug use in the elderly.
To discuss specific cardiovascular medications commonly used in older adults.
To highlight adverse effects, contraindications, and prudent prescribing practices for this population.

Main Methods:

Literature review of pharmacokinetic and pharmacodynamic principles in aging.
Discussion of cardiovascular drug classes including digoxin, diuretics, beta-blockers, ACE inhibitors, ARBs, nitrates, CCBs, alpha-blockers, antiarrhythmics, lipid-lowering agents, and anticoagulants.
Analysis of age-related adverse drug events and medication safety.

Main Results:

Significant age-related changes in drug absorption, bioavailability, distribution, half-life, metabolism, and excretion are discussed.
Altered end-organ responsiveness necessitates careful dosing and monitoring of cardiovascular drugs.
Specific cardiovascular drug classes require tailored approaches due to geriatric physiology.

Conclusions:

Prudent use of cardiovascular medications in the elderly requires understanding age-related physiological changes.
Identifying and avoiding medications with high risks in older adults is crucial.
Optimizing cardiovascular drug therapy in the elderly improves outcomes and minimizes adverse events.