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Drug Dosing: Geriatric Patients01:15

Drug Dosing: Geriatric Patients

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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...
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Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Distribution01:00

Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Distribution

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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...
382
Insulin: Dosing Regimen and Adverse Effects01:16

Insulin: Dosing Regimen and Adverse Effects

1.3K
Insulin-replacement therapy usually includes both long-acting insulin (basal) and short-acting insulin (to cater to postprandial needs). In a diverse group of type 1 diabetes patients, the average daily insulin dose is typically 0.5-0.7 units/kg body weight. However, obese patients and pubertal adolescents may need more due to insulin resistance.
The basal dose constitutes about 40%-50% of the total daily dose, with the rest as premeal insulin. The mealtime insulin dose should mirror...
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Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Metabolism01:18

Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Metabolism

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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...
400
Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Excretion01:18

Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Excretion

354
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...
354
Pharmacodynamics in Geriatric Patients: Effects of Age01:27

Pharmacodynamics in Geriatric Patients: Effects of Age

367
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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Improving IV Insulin Administration in a Community Hospital
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Do geriatrics require dose titration for antidiabetic agents?

R Shastry1, P Adhikari, A Kamath

  • 1Department of Pharmacology, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India.

Journal of Postgraduate Medicine
|December 19, 2013
PubMed
Summary
This summary is machine-generated.

Geriatric patients with type 2 diabetes require significantly lower doses of sulfonylureas and metformin compared to younger adults. This study highlights the need for adjusted antidiabetic medication, particularly smaller dosage formulations, for elderly individuals.

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Area of Science:

  • Endocrinology
  • Geriatric Medicine
  • Pharmacology

Background:

  • Type 2 diabetes mellitus (T2DM) management requires careful consideration of patient age and renal function.
  • Geriatric populations often exhibit altered pharmacokinetics and pharmacodynamics, necessitating dosage adjustments for medications.
  • Creatinine clearance (Crcl) is a key indicator of renal function, crucial for safe and effective drug dosing.

Purpose of the Study:

  • To compare antidiabetic drug dosages between geriatric (≥60 years) and nongeriatric (<60 years) patients with T2DM.
  • To evaluate the influence of disease duration and creatinine clearance (Crcl) on these dosage differences.
  • To provide evidence-based recommendations for optimizing antidiabetic medication in the elderly.

Main Methods:

  • A prospective study was conducted over 6 months in a tertiary care hospital.
  • Patients with T2DM were categorized into geriatric and nongeriatric groups.
  • Drug doses, disease duration, and serum creatinine were recorded; Crcl was calculated using the Cockcroft-Gault formula. Sulfonylurea (SU) doses were converted to glibenclamide equivalents.

Main Results:

  • Significant dose reductions were observed for glibenclamide (25%), gliclazide (25%), and glimepiride (22%) in geriatric patients compared to nongeriatric patients.
  • Mean equivalent SU monotherapy doses were 50% lower in geriatrics (3.2±0.5 mg) versus nongeriatrics (6.4±1.02 mg; P=0.01).
  • Metformin doses showed a modest 5% reduction in geriatrics (901±32.2 mg vs 946.7±45.8 mg; P=0.45), with no significant differences for thiazolidinediones or insulin.

Conclusions:

  • Geriatric patients with T2DM generally require substantially lower doses of certain antidiabetic medications, including sulfonylureas and metformin.
  • The findings support the use of smaller dosage formulations (e.g., 0.75 mg glibenclamide, 0.5 mg glimepiride, 20 mg gliclazide, 250 mg metformin) for geriatric diabetic practice.
  • Age-related changes in drug metabolism and excretion necessitate individualized dosing strategies in elderly diabetic patients.