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Copyright © 2015 Cengage Learning® Chapter 27 Drugs and Older Adults.

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Presentation on theme: "Copyright © 2015 Cengage Learning® Chapter 27 Drugs and Older Adults."— Presentation transcript:

1 Copyright © 2015 Cengage Learning® Chapter 27 Drugs and Older Adults

2 Copyright © 2015 Cengage Learning® Introduction Today, people are living longer and are taking more medications –Forty percent of people of age 60 years and older in the U.S. take at least five prescribed medications, and many add OTC medications and supplements Increased serious complications resulting from adverse drug reactions 2

3 Copyright © 2015 Cengage Learning® Introduction (cont’d.) About 50% of hospitalizations are the result of adverse drug effects in the elderly –In 2012, an estimated 100,000 deaths annually were caused by medication-related problems (MRPs) MRPs can be mistaken for what is often considered a normal consequence of aging or for progression of disease Cognitive impairment and behavioral changes are frequently the result of drug therapy 3

4 Copyright © 2015 Cengage Learning® Introduction (cont’d.) The aging process is an individualized matter –Because of genetic or environmental factors or good health practices, some older adults may not feel or appear particularly different However, there are gradual changes in body composition and organ function as we grow older These changes can affect the reaction to drugs and make the individual more sensitive to a wide variety of medications 4

5 Copyright © 2015 Cengage Learning® Physiological Changes with Age Complex changes of aging involve both anatomic and physiological factors –Affect how drugs are processed in the body Absorption Distribution Metabolism (biotransformation) Excretion 5

6 Copyright © 2015 Cengage Learning® Physiological Changes with Age (cont’d.) Cumulative effects of drugs in older adults can be due to: –Inadequate absorption –Impaired distribution –Slower metabolism –Impaired excretion 6

7 Copyright © 2015 Cengage Learning® Physiological Changes with Age (cont’d.) Absorption –Gastric motility decreases –Gastric acid production diminishes, increasing the gastric pH, causing a more alkaline environment –Many older adults also take medication that reduces gastric acid Examples: ranitidine (Zantac) or omeprazole (Prilosec) Antacids are also used frequently 7

8 Copyright © 2015 Cengage Learning® Physiological Changes with Age (cont’d.) Distribution –Once drugs are absorbed and enter the circulation, many of them bind to proteins Albumin: principal protein used to bind drugs –As we age, the liver produces less albumin Allows more of the drug to be unbound (free) to reach receptor sites and therefore have a greater than expected response 8

9 Copyright © 2015 Cengage Learning® Physiological Changes with Age (cont’d.) –Phenytoin (Dilantin) responds quite noticeably to drops in plasma albumin levels 9

10 Copyright © 2015 Cengage Learning® Physiological Changes with Age (cont’d.) Metabolism –The liver serves as a major site for drug metabolism As we age, the mass of functional liver tissue and blood flow to the liver decreases Ability of the liver to break down drugs declines, and drugs remain in the body longer Repeated dosing can result in the accumulation of the drug and increases the risk for toxicity 10

11 Copyright © 2015 Cengage Learning® Physiological Changes with Age (cont’d.) Excretion –In the older adult, kidney size, blood flow, and glomerular filtration all decrease, resulting in a decline in creatinine clearance Illnesses such as hypertension, heart failure, and diabetes add to the age-related loss and further reduce creatinine clearance 11

12 Copyright © 2015 Cengage Learning® Physiological Changes with Age (cont’d.) –Drug by-products normally eliminated through the kidneys can accumulate Can lead to toxic effects 12

13 Copyright © 2015 Cengage Learning® Physiological Changes with Age (cont’d.) Seniors and drug development –Pharmaceutical research is frequently focused on younger individuals –Older adults are often excluded from or underrepresented in clinical trials Results may be inappropriately extrapolated to other populations with negative outcomes 13

14 Copyright © 2015 Cengage Learning® Physiological Changes with Age (cont’d.) –Some medicines safe for a 30-year-old may produce unexpected results in a person over age 50 or 60 Example: digoxin (Lanoxin) 14

15 Copyright © 2015 Cengage Learning® Potentially Inappropriate Medication Use in Older Adults The Beers List –Results of a survey conducted to determine the most inappropriate drugs for ambulatory nursing home residents and adults 65 or older 15

16 Copyright © 2015 Cengage Learning® Potentially Inappropriate Medication Use in Older Adults (cont’d.) –Goal to improve care of older adults by reducing their exposure to potentially inappropriate medications (PIMs) Health care professionals treating older adults should have ready access to the Beer’s List and recognize common classes of medications that can produce problems 16

17 Copyright © 2015 Cengage Learning® Drugs to Avoid with Certain Medical Conditions Drugs that produce significant anticholinergic effects –Antipsychotic agents –Antidepressants –Antiparkinson agents –Antispasmodics –Antihistamines 17

18 Copyright © 2015 Cengage Learning® Drugs to Avoid with Certain Medical Conditions (cont’d.) Drugs that can cause mental impairment –Anticholinergics –Antidepressants and antipsychotics –Benzodiazepines –Corticosteroids –H 2 receptor antagonists –Meperidine –Phenothiazines –Sedative hypnotics 18

19 Copyright © 2015 Cengage Learning® Drugs to Avoid with Certain Medical Conditions (cont’d.) Drugs that can cause or contribute to syncope/falls –Anticonvulsants –Antidepressants –Antipsychotics –Alpha blockers –Benzodiazepines –Nonbenzodiazepine hypnotics 19

20 Copyright © 2015 Cengage Learning® Drugs to Avoid with Certain Medical Conditions (cont’d.) Gastrointestinal conditions –Anyone taking NSAIDs should be cautioned about the real danger of serious complications In older adults, there may be no warning signs of pain, and the first symptoms of trouble may be a “silent” bleed that could lead to fatal GI hemorrhage Key to avoiding problems with NSAIDs is to use the lowest effective dose for the shortest period of time 20

21 Copyright © 2015 Cengage Learning® Drugs to Avoid with Certain Medical Conditions (cont’d.) –Avoid prolonged use (no longer than two weeks) of OTC antacids without medical supervision –Constipation can be worsened by anticholinergics and oral antimuscarinics (e.g., oxybutynin, tolterodine) for urinary incontinence 21

22 Copyright © 2015 Cengage Learning® Drugs to Avoid with Certain Medical Conditions (cont’d.) Cardiovascular disease –Studies have indicated increased risk of cardiovascular problems (thrombotic events, MI, and stroke) with the use of NSAIDs and COX-2 inhibitors –Older adult patients with heart failure should avoid the calcium-channel blockers diltiazem and verapamil, the antidiabetic glitazones (Actos, Avandia), cilostazol (Pletal), and dornedarone (Multaq) 22

23 Copyright © 2015 Cengage Learning® Polypharmacy Individuals, especially older adults, may be the victims of polypharmacy –Excessive use of multiple drugs OTC, herbals, or prescriptions given at one time for the treatment of a patient’s medical conditions –Polypharmacy becomes problematic when negative outcomes occur May result in unnecessary prescriptions, increased risk of dangerous interactions with potentially serious adverse side effects, and possible medication nonadherence 23

24 Copyright © 2015 Cengage Learning® Polypharmacy 24

25 Copyright © 2015 Cengage Learning® Polypharmacy (cont’d.) Helpful guidelines –Educate yourself, your patients, and their families –With newly prescribed drugs, note diagnoses, allergies, and other medications –Monitor long-term drug use –Question any inappropriate medicine or dosage –Document all adverse side effects, calls to the physician, and action taken 25


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