| Term | Definition |
|---|
| Increased risk of ADE | >6 chronic dx, >9 meds/day, hx prior drug rxn, low BMI, > 85 y/o |
| Improving compliance | Education. Print info for instructions. Simplify plan (change time of day, not splitting pills). Frequent review of meds. |
| Aging effects on Absorption | Increased gastric pH and transit time. Decreased gastric secretions (less ability to breakdown drugs). Decreased blood flow to muscles. Overall: unpredictable rates of breakdown & absorption. |
| Aging effects on Distribution | Decreased lean body mass (increased peak levels of drug), albumin levels (less protein for certain drugs to bind to = increased drug conc), & total body water (increased risk of toxicity for water soluble drugs). Increased total body fat (increased storage of fat soluble drugs & increased toxicity). |
| Aging effects on Metabolism | Decreased liver mass, blood flow & enzyme activity (decreased clearance or elmination of drug). Elderly patients may need smaller doses because of altered first pass and P450 enzyme metabolism. |
| Aging effects on Elimination | Decreased GFR (50% overtime = prolonged 1/2 life). Decreased tubular secretions. |
| Medication adjustments | Make med adjustments for CrCl around 50 and then again around 30. |
| Increased drug response in elderly (drug classes) | Barbituates, benzos, morphine, anticoagulants |
| Decreased drug response in elderly (drug types) | Tolbutamide, isoproteranol |
| Drugs given in reduced dosage to elderly | aminoglycosides (nephrotoxicity), carbamazepine (sedation), cimetidine (confusion), digoxin (increased toxicity), levodopa (hypotension), meperidine (resp depression), metoclopramide (confusion), thioridazine (confusion) |
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