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Related Concept Videos

Drug Dosing: Geriatric Patients01:15

Drug Dosing: Geriatric Patients

48
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 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 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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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 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

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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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[Polypharmacy in elderly patients].

R J van Marum1,2, J S Burgers3, M L Bouvy4

  • 1Amsterdam UMC, locatie VUmc, Amsterdam Public Health research institute, afd. Huisartsgeneeskunde en Ouderengeneeskunde, Amsterdam(tevens: Jeroen Bosch Ziekenhuis, afd. Geriatrie en afd. Klinische Farmacologie, 's-Hertogenbosch).

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Summary
This summary is machine-generated.

As people age, polypharmacy increases, raising the risk of inappropriate medication use. This article guides physicians on rational prescribing and deprescribing using WHO guidelines and specific tools.

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Area of Science:

  • Geriatrics
  • Clinical Pharmacology
  • Public Health

Background:

  • Aging populations experience a rise in polypharmacy, defined as the concurrent use of multiple medications.
  • Increased medication use elevates the risk of potential inappropriate medication (PIM) prescribing.
  • PIMs can lead to adverse drug events, reduced quality of life, and increased healthcare costs.

Purpose of the Study:

  • To provide physicians with a framework for rational prescribing in elderly patients.
  • To introduce practical tools and methods for assessing medication appropriateness.
  • To outline evidence-based deprescribing strategies according to recent Dutch guidelines.

Main Methods:

  • Application of the World Health Organization's (WHO) 6-step approach for rational drug therapy.
  • Utilizing instruments such as the systemic tool to reduce inappropriate prescribing.
  • Following established Dutch guidelines for medication review and deprescribing.

Main Results:

  • The WHO 6-step model offers a structured approach to optimize medication selection and use.
  • Specific tools aid clinicians in identifying and evaluating PIMs in older adults.
  • Deprescribing, when guided by evidence, can safely reduce medication burden.

Conclusions:

  • Rational prescribing and systematic medication review are crucial for managing polypharmacy in aging individuals.
  • Implementing tools and guidelines facilitates appropriate medication use and deprescribing.
  • Optimizing pharmacotherapy in the elderly improves patient outcomes and reduces healthcare utilization.