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Related Concept Videos

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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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 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 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...
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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...
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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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Development of a Virtual Reality Assessment of Everyday Living Skills
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Recent developments in geriatric psychopharmacology.

Awais Aftab1, Jeffrey A Lam2, Fred Liu3

  • 1Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH, USA.

Expert Review of Clinical Pharmacology
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Summary

Recent geriatric psychiatry advances focus on Alzheimer's disease (AD) treatments and diagnostics. Novel medications show promise for dementia symptoms, but ketamine and cannabinoids lack proven efficacy in older adults.

Keywords:
Alzheimer’s diseaseGeriatric psychiatryanti-amyloid agentscannabinoidsdementiadiagnostic radiotracersesketamineneuropsychiatric symptomspsychedelicspsychopharmacologytreatment-resistant depression

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Area of Science:

  • Geriatric Psychiatry
  • Neuroscience
  • Pharmacology

Background:

  • Growing need for geriatric psychiatric disorder management.
  • Recent focus on Alzheimer's disease (AD), severe depression, and end-of-life care.

Purpose of the Study:

  • Review recent developments in geriatric psychiatry.
  • Highlight advancements in AD, depression, and palliative care treatments.

Main Methods:

  • Non-systematic narrative review.
  • Searched PubMed, Google Scholar, Medscape, ClinicalTrials.gov (last 6 years).
  • Covered AD therapies, radiotracers, dementia symptom medications, ketamine, psychedelics, and cannabinoids.

Main Results:

  • Anti-amyloid agents in Phase 3 for early AD; aducanumab under FDA review.
  • Amyloid and tau PET scans approved for AD diagnosis.
  • Pimavanserin, brexpiprazole, escitalopram, dextromethorphan/quinidine, and lithium show promise for dementia symptoms.
  • Esketamine ineffective in elderly in Phase 3; psychedelic-assisted therapy shows preliminary benefit for end-of-life/cancer depression.
  • Cannabinoid evidence is currently lacking.

Conclusions:

  • Early-stage AD diagnostics and treatments are advancing.
  • Several pharmaceuticals offer potential for neuropsychiatric symptoms of dementia.
  • Esketamine and cannabinoids have limited demonstrated efficacy in geriatric populations.
  • Psychedelics show preliminary promise in specific palliative care contexts.