1. Drug Therapy in the Elderly
Chapter 6
Drug Therapy in the Elderly

2. Chapter Outline: Pharmacodynamic Changes Introduction Polypharmacy
Adverse Drug Reactions
Noncompliance
Causes of noncompliance
Medication Management
Introduction
Pharmacokinetic Changes
Absorption
Distribution
Metabolism
Excretion

3. Pharmacokinetic Changes
Pharmacokinetics is the study of how drugs travel through the body over time. It deals with all aspects of drug disposition in the body, including absorption from the administration site, distribution into various body compartments, hepatic metabolism to active & inactive metabolites, & excretion of parent drug & metabolites from the body.

5. Pharmacodynamic Changes:
Pharmacodynamics refers to the action of drugs, or the biological effects resulting from the interaction between drugs & its receptor site.
Age-related pharmacodynamic changes in the elderly can greatly influence drug response, usually leading to increased sensitivity or an exaggerated pharmacological response to a given drug.

6. Pharmacokinetic Parameter
Absorption
Distribution
Metabolism
Excretion

7. Polypharmacy:
Polypharmacy refers to the use of multiple medications in one individual.
They may be needed but the term polypharmacy usually connotes the use of more drugs than are needed.

8. Polypharmacy:
As the number of medications taken increases, the likelihood of adverse drug reactions & drug-drug interactions also increases.
As the complexity of the drug regimen increases, the risk of noncompliance increases.

9. Reasons for Polypharmacy:
 number of chronic illnesses or physical ailments; a lack of one primary health provider to coordinate medical care & drug use, subsequent use of multiple physicians (specialists), use of multiple pharmacies, & self-treatment, primarily with over-the-counter drugs.
Elderly take an average of 2.8 drugs per day
Nursing homes=3.4 /day;hospitalized=9/day

10. Adverse Drug Reactions:
Any unexpected, unintended, undesired, or excessive response to a drug when it is used in the approved manner. They typically:
Require a modification in drug therapy (drug discontinuation or dosage change)
Cause or prolong admission to the hospital
Require supportive treatment
Negatively affect prognosis & may result in disability or death.

11. Adverse Drug Reaction Risk Factors:
An increased number of chronic illnesses.
Severity of illnesses
Pharmacokinetic changes
Pharmacodynamic changes
Polypharmacy

12. Observed Drug Reactions:
Delirium
Confusion
Lethargy
Fatigue
Arrhythmias
Nausea, vomiting
Incontinence
Tremor
Tardive dyskinesia
Pseudoparkinsonism
Visual/hearing disturbances
Hypotension
Syncopal attacks,falls
Constipation,diarrhea
Electrolyte abnormalities
Urinary retention

13. Noncompliance:
Medication compliance has been defined as the extent to which a patient’s behavior coincides with a prescriber’s planned medical regimen.
Any deviation from this is, obviously, noncompliance.
1.8 billion prescriptions written each year are taken incorrectly. Up to 90% is due to patients taking too little medication.

14. Factors associated-poor compliance:
Female gender
Low socioeconomic status
Solitary living
Lack of a support person
Cognitive impairment
Drug costs
Multiple disease states
Physical disabilities
Complex drug regimens
Polypharmacy
Poor communication

15. Causes of Noncompliance:
Polypharmacy & Complex Drug Regimens
Physical Disabilities
Poor Communication
Cognitive Impairment
Drug Costs

16. Medication Management:
With every new complaint or symptom the drug regimen should be reviewed to identify any adverse drug reactions or rule out drug toxicity. Adverse reactions are often completely reversible-when source removed.

17. Drug Therapy in the Elderly:
Offers tremendous benefits to elderly people when used appropriately.
Periodic review of medication regimens must be done, so that elderly patients receive maximal benefits from drug therapy while minimizing potential adverse outcomes.