Pharmacokinetics and Pharmacodynamic Changes Associated with Aging and Implications for Drug Therapy

Sera, Leah; McPherson, Mary Lynn

doi:10.1016/j.cger.2012.01.007

Cited by 138 publications

(68 citation statements)

References 54 publications

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“…This relative paucity of data in this area may be related to the common practice of excluding older adults from randomized controlled trials (RCTs) due to concerns about safety and/or confounding effects of co-morbid conditions (Pahor and Cesari, 2012; Van Spall et al, 2007). Indeed, numerous challenges exist in the treatment of hypertension among older adults – including and altered drug metabolism (Belmin et al, 2000), multiple concomitant medications and co-morbidities (Benetos et al, 2015), as well as increased blood pressure variability and orthostatic hypotension (Sera and McPherson, 2012) – that make it difficult to obtain definitive evidence of proper treatment guidelines. Still, it is these challenges which make it critical to conduct studies which will improve medical decision making related to the treatment of hypertension among older adults.…”

Section: Introductionmentioning

confidence: 99%

Hypertension and aging

Buford

2016

Ageing Research Reviews

421

289

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Hypertension is a highly prevalent condition with numerous health risks, and the incidence of hypertension is greatest among older adults. Traditional discussions of hypertension have largely focused on the risks for cardiovascular disease and associated events. However, there are a number of collateral effects, including risks for dementia, physical disability, and falls/fractures which are increasingly garnering attention in the hypertension literature. Several key mechanisms – including inflammation, oxidative stress, and endothelial dysfunction – are common to biologic aging and hypertension development and appear to have key mechanistic roles in the development of the cardiovascular and collateral risks of late-life hypertension. The objective of the present review is to highlight the multi-dimensional risks of hypertension among older adults and discuss potential strategies for treatment and future areas of research for improving overall care for older adults with hypertension.

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Section: Introductionmentioning

confidence: 99%

Hypertension and aging

Buford

2016

Ageing Research Reviews

421

289

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“…The changing pathophysiology occurring with the aging process results in complex alterations to the pharmacokinetics and pharmacodynamics of medications [14]. Clinical study has demonstrated that the effectiveness of drugs in geriatrics was substantially metabolized in amounts lower than those standard references doses predicted [15].…”

Section: Discussionmentioning

confidence: 99%

Association between Physician Specialty and Risk of Prescribing Inappropriate Pill Splitting

et al. 2013

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BackgroundPrescription errors that occur due to the process of pill splitting are a common medication problem; however, available prescription information involving inappropriate pill splitting and its associated factors is lacking.MethodsWe retrospectively evaluated a cohort of ambulatory prescriptions involving extended-release or enteric-coated formulations in a Taiwan medical center during a 5-month period in 2010. For this study, those pill splitting prescriptions involving special oral formulations were defined as inappropriate prescriptions. Information obtained included patient demographics, prescriber specialty and prescription details, which were assessed to identify factors associated with inappropriate pill splitting.ResultsThere were 1,252 inappropriate prescriptions identified in this cohort study, representing a prescription frequency for inappropriate pill splitting of 1.0% among 124,300 prescriptions with special oral formulations. Among 35 drugs with special oral formulations in our study, 20 different drugs (57.1%, 20/35) had ever been prescribed to split. Anti-diabetic agents, cardiovascular agents and central nervous system agents were the most common drug classes involved in inappropriate splitting. The rate of inappropriate pill splitting was higher in older (over 65 years of age) patients (1.1%, 832/75,387). Eighty-seven percent (1089/1252) of inappropriate prescriptions were prescribed by internists. The rate of inappropriate pill splitting was highest from endocrinologists (3.4%, 429/12,477), nephrologists (1.3%, 81/6,028) and cardiologists (1.3%, 297/23,531). Multivariate logistic regression analysis revealed that the strongest factor associated with individual specific drug of inappropriate splitting was particular physician specialties.ConclusionThis study provides important insights into the inappropriate prescription of special oral formulation related to pill splitting, and helps to aggregate information that can assist medical professionals in creating processes for reducing inappropriate pill splitting in the future.

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“…In all cases, using the lowest effective dose is recommended because physiologic changes of aging affect drug metabolism such that smaller doses will have the desired effect. 61 Antipsychotics are often a first choice, as they are readily available and can be effective for sedation. They are not risk free.…”

Section: Agitationmentioning

confidence: 99%

Behavioral Health Needs of Older Adults in the Emergency Department

Bessey

Radue

Chapman

et al. 2018

Clinics in Geriatric Medicine

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Behavioral health disorders are common among older adults and, owing to limited access to resources for mental health care in the community, emergency department providers are often on the front lines of mental health crises. This article reviews the available literature regarding the care of behavioral health emergencies in older adults and provides a framework for navigating the evaluation and management of older adults presenting to the emergency department with behavioral health concerns.

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Pharmacokinetics and Pharmacodynamic Changes Associated with Aging and Implications for Drug Therapy

Cited by 138 publications

References 54 publications

Hypertension and aging

Hypertension and aging

Association between Physician Specialty and Risk of Prescribing Inappropriate Pill Splitting

Behavioral Health Needs of Older Adults in the Emergency Department

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