Problems in Drug Management of Cardiovascular Disorders in Geriatric Patients*

Keyes, John W.

doi:10.1111/j.1532-5415.1965.tb00700.x

Cited by 9 publications

(6 citation statements)

References 6 publications

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“…Over the past ten years, evidence has accumulated which supports an already generally accepted view that the probability of experiencing adverse drug reactions increases with age (1, 2). During this same period, it has become increasingly appreciated that the activities of some drugs are modified in the geriatric patient and that these variations should be acknowledged in therapeutic regimens prescribed for patients in this age group (3)(4)(5)(6)(7)(8)(9)(10)(11).…”

mentioning

confidence: 99%

Pharmacodynamic Principles of Drug Therapy in the Aged*

Bender¹

1974

J American Geriatrics Society

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The geriatric patient responds differently to some drugs than does the younger adult, and consequently certain precautions should be taken when prescribing a therapeutic regimen for the elderly. Increasing age is accompanied by functional changes in many of the systems that control the way a drug is metabolized and the response that it evokes. Apparently it is these changes which underlie the modified effect seen clinically in geriatric patients. Age tends to reduce and delay the absorption of substances from the gastrointestinal tract, impair and delay drug clearance and excretion by the kidneys, and reduce the rate of enzyme destruction. The plasma half‐life of penicillin, digoxin, antipyrine, or phenylbutazone is extended significantly in the aged so that higher circulating concentrations are maintained for longer periods. Other age‐related changes influence the effect of a drug once it has combined with its receptor. These include an altered number of receptor sites, a decrease in the transmitter content of affected tissues, an increase in the rigidity of responsive tissues, and an overall decline in homeostatic capability.

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confidence: 99%

Pharmacodynamic Principles of Drug Therapy in the Aged*

Bender¹

1974

J American Geriatrics Society

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“…Reserpine also depresses norepinephrine at peripheral sites and thus is useful in the treatment of mild hypertension (38). Keyes (39) noted that rauwolfia may have certain undesirable effects in the elderly, particularly aggravation or precipitation of mental depression. Parker and Murphy (40) reported that the risk of depression during reserpine therapy was nearly doubled in patients over 40 compared to those under 40.…”

Section: Drug Therapymentioning

confidence: 99%

Fluorescein Circulation Time and the Treatment of Hypertension in the Aged*

Fishback

1973

J American Geriatrics Society

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An objective test for circulation time was performed in rabbits with the use of various dyes, of which the best was 10% fluorescein. The average circulation time in rabbits was 5–6 seconds. Serum from hypertensive patients injected intravenously into rabbits usually prolonged the circulation time. Differences in the results based on the age of the patients indicated a more benign type of hypertension in the elderly. An outline is given of the treatment of hypertension in the aged. Many cases respond fairly well to reassurance, a low‐salt diet, and weight reduction when the patient is obese. If additional measures are needed, diuretics are effective, especially furosemide (40 mg once or twice daily). In moderate or severe hypertension with renal parenchymal disease and a high level of blood urea nitrogen, methyldopa (250 mg two to four times daily) is of value. Potassium supplements should be given along with diuretics. In the Philadelphia Geriatric Center there are 325 residents, nearly all between the ages of 70 and 100; and more than 140 of them have hypertension. There are about 100 cases of depression (present or past), 75 cases of hiatal hernia (some with ulcer), and 53 cases of peptic ulcer. Since reserpine can aggravate peptic ulcer and can precipitate or aggravate depression, it should not be used to treat hypertension in the aged; nor should guanethidine be used for this purpose, since it can cause weakness and cerebrovascular insufficiency. High blood pressure should be reduced slowly in the aged, to avoid untoward effects.

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“…Of the diuretics, perhaps the most popular are the thiazide compounds. With these drugs, the elderly patient is more apt to exhibit signs of potassium depletion (13), resulting in an increase in sensitivity to the actions of digitalis. Also, in the elderly patient, the margin of safety between the therapeutic effect and the toxic effect of digitalis may be greatly reduced (15).…”

Section: Clinical Studiesmentioning

confidence: 99%

“…Hypertension in the elderly is a problem, as is the decision as to whether or not it should be treated (13). Modifying various homeostatic mechanisms in order to achieve a reduction in blood pressure may cause reduced cardiac output and hypotension with resulting insufficiency of the cerebral and coronary arteries.…”

Section: Clinical Studiesmentioning

confidence: 99%

Pharmacologic Aspects of Aging: Additional Literature

Bender¹

1967

J American Geriatrics Society

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Problems in Drug Management of Cardiovascular Disorders in Geriatric Patients*

Cited by 9 publications

References 6 publications

Pharmacodynamic Principles of Drug Therapy in the Aged*

Pharmacodynamic Principles of Drug Therapy in the Aged*

Fluorescein Circulation Time and the Treatment of Hypertension in the Aged*

Pharmacologic Aspects of Aging: Additional Literature

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