[Current Challenges in Pharmacotherapy].

Area of Science:

• Pharmacology
• Geriatric Medicine
• Clinical Pharmacy

Background:

• Preoperative medication analysis assesses risks of continuing or stopping medications before surgery.
• Adverse drug reactions (ADRs) and medication interactions present significant challenges, often leading to uncertainty.
• Medication underuse and overuse, particularly in older, multi-morbid patients, can exacerbate geriatric syndromes.

Purpose of the Study:

• To highlight the complexities and risks associated with preoperative medication management.
• To emphasize the challenges in identifying and managing adverse drug reactions and medication interactions.
• To underscore the increased vulnerability of older, multi-morbid, and multi-medicated patients to medication-related issues.

Main Methods:

• Review of challenges in preoperative medication management, including underuse and overuse.
• Analysis of consequences of polypharmacy and medical overuse, such as drug interactions and ADRs.
• Consideration of pharmacokinetic factors, including drug metabolism via CYP enzymes (CYP2D6, CYP2C9, CYP2C19, CYP3A4) and their impact on drug exposure.

Main Results:

• Medication overuse is often harder to detect than underuse, especially with drug interactions and individual patient factors.
• Consequences of polypharmacy include increased drug interactions, ADRs, medication errors, and worsening of geriatric syndromes.
• Pharmacogenetic variations in CYP enzyme activity can alter drug exposure, and CYP3A4 interactions are common.

Conclusions:

• Effective preoperative medication management requires careful assessment of benefits and risks.
• Older, multi-morbid, and multi-medicated patients are at higher risk for ADRs and require specialized attention.
• Understanding drug metabolism and interactions is critical for optimizing medication regimens and patient safety during the perioperative period.