Pharmacotherapy In The Older Patient

Front 1

Age-Related Changes in Pharmacokinetics: Absorption, Distribution, Hepatic Metabolism, Renal Excretion

Back 1

1. Absorption: no significant changes
2. Distribution: increased Vd lipophilic drug (increased fat), decreased Vd hydrophilic drug (decreased water), decreased binding acidic drugs/increased free drug (decreased albumin), increased binding of basic drugs (increased alpha-1-glycoprotein)
3. Hepatic Metabolism: decreased phase I reactions (build-up of active metabolites), no change in phase II reactions
4. Renal Excretion: reduced by 30-50%

Front 2

Age-Related Changes in Pharmacodynamics: Increased Sensitivity, Decreased Sensitivity

Back 2

1. Increased Sensitivity: sedative hypnotics, anticholinergics, analgesics, warfarin
2. Decreased Sensitivity: beta-adrenergic stimulants and blockers, alpha-adrenergic stimulants

Front 3

Age-Related Changes in Adverse Drug Reactions: Increased Risk Factors, Unique Presentation

Back 3

1. Increased Risk Factors: # of medications, comorbidities >6, Low BMI, age >85, impaired renal function
2. Unique Presentation: delerium, falls, fractures, urinary incontenence/retention, fecal incontenence/constipation, orthostatic hypotension, renal impairment

Front 4

Is Adherence/Compliance to Medications Different in Elderly?

Back 4

No

Front 5

Adverse Effects in Neuroleptics: Sedation, Anticholinergic, Orthostasis, Extrapyramidal

Back 5

1. Sedation: Olanzapine>Quetiapine>Resperidone
2. Anticholinergic: Olanzapine>Quetiapine
3. Orthostasis: Resperidone>Quetiapine
4. Extrapyramidal: Haloperidol>Resperidone