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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

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

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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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In patients with renal impairment, drugs undergo significant changes in their pharmacokinetics, which require dosage adjustments to ensure safe and effective therapy.
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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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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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The Fall Risk with Alpha blockers Given InitiaL dose or Elderly status (FRAGILE) Study.

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Alpha-1 blockers did not significantly increase adverse drug events (ADEs) or fall-related side effects in at-risk veterans. Pharmacists can help optimize medication use to minimize potential risks.

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Area of Science:

  • Pharmacology
  • Geriatrics
  • Patient Safety

Background:

  • Alpha-1 adrenergic antagonists are widely prescribed.
  • Safety concerns exist for patients at increased risk of falls.
  • The FRAGILE study investigated these safety concerns.

Purpose of the Study:

  • To determine the risk of adverse drug events (ADEs) in veterans prescribed alpha-1 blockers.
  • To compare ADEs in at-risk versus control groups.
  • To evaluate fall-related ADEs and discontinuation rates.

Main Methods:

  • Retrospective, observational cohort study of 300 veterans.
  • Categorized veterans into at-risk (age ≥ 65 or high initial dose) and control groups.
  • Primary outcome: composite all-cause ADEs (hospitalizations, ED visits); Secondary outcomes: fall-related ADEs, discontinuation rates.

Main Results:

  • No significant difference in composite all-cause ADEs between at-risk and control groups.
  • No significant differences in secondary outcomes, including fall-related ADEs.
  • Fall-related side effects occurred in 8% of the total cohort.

Conclusions:

  • Alpha-1 blockers did not significantly increase all-cause or fall-related ADEs in this veteran cohort.
  • An 8% discontinuation rate due to fall-related ADEs was observed.
  • Pharmacists can optimize alpha-1 blocker administration, considering co-prescribed medications.