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

Pharmacodynamics in Geriatric Patients: Effects of Age

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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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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...
271
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...
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Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Absorption01:22

Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Absorption

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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...
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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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Pharmacological considerations in the elderly.

Shamsuddin Akhtar1

  • 1Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut, USA.

Current Opinion in Anaesthesiology
|December 1, 2017
PubMed
Summary
This summary is machine-generated.

Anesthetic drug potency increases with age, requiring adjusted dosing in geriatric patients. Current practices often underappreciate this, leading to adverse outcomes. Age-appropriate anesthetic management is crucial for elderly patient safety.

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Area of Science:

  • Anesthesiology
  • Geriatric Pharmacology
  • Neuroscience

Background:

  • Aging alters neurophysiology and receptor function, increasing sensitivity to anesthetic agents.
  • Current anesthetic drug management in the elderly often fails to account for age-related changes.
  • Geriatric patients have reduced physiological reserves, making them more vulnerable to anesthetic complications.

Purpose of the Study:

  • To review the pharmacology of anesthetic medications in geriatric patients.
  • To discuss age-related neurophysiological changes and their impact on anesthetic drug response.
  • To evaluate current dosing recommendations, practice patterns, and future directions in elderly anesthetic management.

Main Methods:

  • Review of contemporary anesthetic pharmacology in geriatric populations.
  • Analysis of neurophysiological changes associated with aging.
  • Examination of current practice patterns and ongoing research.

Main Results:

  • Anesthetic drug potency is significantly increased in elderly individuals.
  • Age-related neurophysiological changes, including altered functional connectivity, enhance sensitivity to anesthetics.
  • Intraoperative hypotension and central nervous system depression are linked to poor perioperative outcomes in the elderly, often due to underappreciated dose reductions.

Conclusions:

  • Anesthetic dosing must be more closely age-adjusted to prevent hypotension and excessive anesthetic depth in the elderly.
  • Further pharmacologic research specifically in the population over 80 years is essential.
  • Improved anesthetic management strategies are needed to optimize perioperative outcomes for geriatric patients.