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Related Concept Videos

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...
306
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...
245
Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Distribution01:00

Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Distribution

283
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...
283
Lipid-Lowering Drugs: Statins and Miscellaneous Agents01:20

Lipid-Lowering Drugs: Statins and Miscellaneous Agents

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Hyperlipidemia, a medical condition often referred to as high cholesterol, is characterized by abnormally elevated levels of lipids in the bloodstream. When present in excess, these lipids, specifically cholesterol and triglycerides, can lead to serious health complications, often involving cardiovascular diseases. Illnesses like atherosclerosis, heart attacks, and pancreatitis have all been linked to untreated hyperlipidemia. This means controlling and regulating cholesterol and triglyceride...
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Pharmacodynamics in Geriatric Patients: Effects of Age01:27

Pharmacodynamics in Geriatric Patients: Effects of Age

254
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...
254
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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Related Experiment Videos

Statin Prescribing in the Elderly: Special Considerations.

M Leya1, N J Stone2

  • 1Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. Marysa-leya@northwestern.edu.

Current Atherosclerosis Reports
|October 12, 2017
PubMed
Summary

Prescribing statins for primary prevention in adults over 75 requires careful consideration of benefits versus risks. Evidence is limited for those over 85, emphasizing individualized treatment decisions for older adults.

Keywords:
Adverse effectsElderlyPrimary preventionSecondary preventionStatinTreatment risk paradox

Related Experiment Videos

Area of Science:

  • Cardiology
  • Geriatrics
  • Pharmacology

Background:

  • Statins are widely used for cardiovascular disease prevention.
  • Older adults, especially those over 75, are often underrepresented in clinical trials.
  • Polypharmacy and comorbidities are common in the elderly, increasing risks of adverse effects and drug interactions.

Purpose of the Study:

  • To review the evidence for statin use in individuals over 65, with a focus on those older than 75.
  • To evaluate the benefits and risks of statin therapy in elderly populations for primary and secondary prevention.
  • To inform clinical decision-making regarding statin prescription in older adults.

Main Methods:

  • Review of randomized controlled trials (RCTs) and clinical guidelines.
  • Analysis of evidence from primary prevention trials, including JUPITER and HOPE-3.
  • Assessment of reported adverse effects and their incidence compared to placebo.

Main Results:

  • Statins show benefit in primary prevention for individuals over 70, but evidence is insufficient for those over 85.
  • Common adverse effects include new-onset diabetes and myopathy; cognitive decline was not significantly different from placebo.
  • Concerns regarding liver and kidney injury were not substantiated by RCTs.
  • For most patients, ASCVD risk reduction outweighs risks, but cognitive, musculoskeletal, and independence impacts are critical in the elderly.

Conclusions:

  • Current guidelines do not recommend statins for primary prevention in individuals over 75 due to limited evidence.
  • Physician judgment and shared decision-making are essential when considering statins for this population.
  • Further research, potentially using imaging studies, may help refine statin therapy selection for ASCVD prevention in the elderly.