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Related Concept Videos

Drug Dosing: Geriatric Patients01:15

Drug Dosing: Geriatric Patients

345
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...
335
Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Excretion01:18

Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Excretion

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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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Dosage Regimen: Individualization01:24

Dosage Regimen: Individualization

279
Individualization in dosing regimens is the customization of medication doses for individual patients. Its necessity arises from the goal of maximizing therapeutic benefits while minimizing risks. This approach is pivotal because human responses to drugs can vary widely; what is effective for one person may be inadequate or excessive for another. Interpatient (intersubject) variability refers to differences in drug responses between individuals, while intrapatient (intrasubject) variability...
279
Pharmacodynamics in Geriatric Patients: Effects of Age01:27

Pharmacodynamics in Geriatric Patients: Effects of Age

315
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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Heart Failure Drugs: Inotropic Agents01:26

Heart Failure Drugs: Inotropic Agents

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Positive inotropic agents are commonly used as the first line of treatment for heart failure. One such agent is digoxin, derived from the genus Digitalis, which has been known for centuries but effectively utilized since 1785. However, these cardiac glycosides can have potentially toxic effects due to their mechanism of action, which involves inhibiting Na+/K+-ATPase and increasing contractility. Digoxin is absorbed orally and distributed in various tissues, including the CNS. It has a long...
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A New Method for Individualized Digoxin Dosing in Elderly Patients.

Ana Martin-Suarez1,2, David García González3, Juan F Macías Núñez4,2

  • 1Department of Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, University of Salamanca, Salamanca, Spain.

Drugs & Aging
|February 3, 2016
PubMed
Summary

The HUGE value effectively predicts initial digoxin doses in elderly patients, outperforming traditional methods. This new equation ensures safer and more accurate medication management for seniors with potential kidney issues.

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Area of Science:

  • Geriatric Pharmacology
  • Nephrology
  • Clinical Pharmacy

Background:

  • Digoxin is commonly prescribed for elderly patients.
  • Estimated glomerular filtration rate (eGFR) is standard for digoxin dose adjustment.
  • The HUGE value aids in identifying chronic kidney disease in older adults.

Purpose of the Study:

  • To evaluate the HUGE value's utility in predicting initial digoxin dosage for patients over 70.
  • To develop and validate a digoxin dosing equation using the HUGE value.

Main Methods:

  • Retrospective review of 63 elderly patients' medical records with monitored serum digoxin concentrations (SDCs).
  • Development of a linear regression equation (HUGE_DIG) relating SDC, digoxin dose, and HUGE value.
  • Validation of the HUGE_DIG equation retrospectively (33 patients) and prospectively (35 patients) against creatinine clearance-based methods.

Main Results:

  • A validated digoxin dosing equation (HUGE_DIG) was generated to achieve target SDCs.
  • For a target SDC of 0.8 ng/mL, the equation is: Digoxin (mg/day) = 0.091 - 0.006 x HUGE.
  • Prospective validation showed no statistical difference between measured and desired SDCs, with improved predictive performance over existing methods.

Conclusions:

  • A novel, validated digoxin dosing equation (HUGE_DIG) is presented for elderly patients.
  • Emphasizes considering age-related renal physiological changes beyond eGFR for digoxin dosing in the elderly.
  • Supports the clinical utility of the HUGE value for optimizing digoxin therapy in geriatric populations.