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Related Concept Videos

Pharmacovigilance01:19

Pharmacovigilance

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Post-marketing surveillance is a critical component of pharmaceutical regulation, often uncovering unanticipated adverse drug reactions (ADRs) once a drug is widely used over an extended period.
This process, termed pharmacovigilance, aims to detect, evaluate, and minimize harmful effects related to medication use. The data collection for pharmacovigilance depends on spontaneous reporting systems, where healthcare professionals or patients voluntarily report suspected ADRs.
In some cases, there...
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Dosage Regimens: Partial Pharmacokinetic Parameters01:01

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It is not uncommon for complete drug pharmacokinetic profiles to remain elusive in pharmacokinetics. This necessitates certain educated assumptions by pharmacokineticists to determine appropriate dosage regimens without comprehensive pharmacokinetic data from animal or human studies. One prevalent assumption is setting the bioavailability factor, denoted as F, to 1 or 100%. This assumption caters to the scenario where a drug doesn't achieve full systemic absorption, resulting in the patient...
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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 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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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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Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
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Inappropriate Medication Use and Association With Polypharmacy in Surgical Patients: A Retrospective,

Freyja Jónsdóttir1,2, Anna B Blöndal1,3, Aðalsteinn Guðmundsson4,5

  • 1Faculty of Pharmaceutical Sciences, University of Iceland, Reykjavik, Iceland.

Acta Anaesthesiologica Scandinavica
|September 9, 2025
PubMed
Summary

Potentially inappropriate medication use is common in older surgical patients, especially those with polypharmacy. This increases risks of harm, mortality, and longer hospital stays, highlighting the need for medication review.

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Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
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Inverse Probability of Treatment Weighting Propensity Score using the Military Health System Data Repository and National Death Index
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Area of Science:

  • Geriatric Medicine
  • Surgical Care
  • Pharmacology

Background:

  • Assessing the prevalence and incidence of potentially inappropriate medication (PIM) use in older surgical patients.
  • Investigating the association between PIM use and polypharmacy in this demographic.

Purpose of the Study:

  • To determine the prevalence and incidence of PIM use among older patients undergoing surgery.
  • To examine the relationship between PIM use and different levels of polypharmacy (non-polypharmacy, polypharmacy, hyper-polypharmacy).
  • To identify risk factors for PIM use and its impact on postoperative outcomes.

Main Methods:

  • Retrospective, population-based cohort study of patients aged 65+ undergoing their first surgery.
  • Data collected from Landspitali-The National University Hospital of Iceland between 2005 and 2018.
  • Patients categorized by medication use (non-polypharmacy <5, polypharmacy 5-9, hyper-polypharmacy ≥10) pre- and post-surgery. PIM use assessed using 2019 Beers criteria.

Main Results:

  • 17,198 surgical admissions analyzed; 53.8% female, median age 75.
  • PIM prevalence: 36.6% (non-polypharmacy), 80.2% (polypharmacy), 95.8% (hyper-polypharmacy).
  • New PIM use post-surgery in 38.5%. Risk factors: female sex, comorbidities, prior multidose dispensing.
  • PIM use linked to higher medication-related harm, 30-day mortality (5.2% vs 0.3%), longer hospital stays, and increased 30-day readmissions.

Conclusions:

  • Potentially inappropriate medication use is highly prevalent and strongly associated with polypharmacy/hyper-polypharmacy in older surgical patients.
  • Adverse outcomes, including medication-related harm, mortality, and extended hospital stays, are significantly increased in patients using PIMs.
  • Surgical hospitalization presents a crucial opportunity for medication review, deprescribing, and planning to mitigate medication-related harm.