Medications and Older Adults

adverse drug event

any noxious, unintended, and undesired effects of a drug that occur at doses used for prevention, diagnosis, or treatment

classification of ADR

A: dose- related (augmented or amplified)

B: non-dose related (bizarre)

C: dose-related and time-related (chronic)

D: time-related (delayed)

E: withdrawl (end of use)

F: unexpected failure of therapy (failure)

risk factors for ADR

6+ conditions, 12+ doses of meds, 9+ meds, prior ADR, low BMI, age 85+, impaired renal function (CrCI < 50mL/min)

ADR common types of meds

hematologic agents, endocrine agents, CV agents, CNS agents, or anti-infective agents

ADR main issues

bleeding (GI, ICH, hemoptysis), hypoglycemia (LOC, seizures, change in mental state), electrolyte or volume imbalance (non-specific weakness)

physiology changes in older adults impacting meds

increased body fat, decreased plasma volume, decreased total body water, decreased extracellular fluid

polypharmacy

5+ meds, significant potential for drug interactions or poor adherence

Beers Criteria

document of potentially inappropriate medications that should be avoided by most older people, in combination with other treatments, used with caution, and dosed differently

anticholinergic medications

Drugs that block acetylcholine

-more than 600 meds have this property

• central effects: headache, impaired memory, reduced cognitive function, anxiety, insomnia, and at near-toxic doses: agitation, confusion, delirium, seizures

• peripheral effects: vision (blurred, doubled, focus issue) salivation (dry mouth, reduced appetitie) heart (tachycardia, arrhythmias), GI system (decreased secretions and motility, nausea, vomiting, constipation) Urinary (inhibition of bladder contraction, retention) temperature dysregulation (inhibition of sweating, hyperthermia), and muscle weakness

• therapeutic anticholinergics: tiotropium (Spiriva) inhaled for COPD; oxybutynin and tolterodine for urge incontinence and hyperactive bladder; diphenhydramine (Benadryl) as a sleep aid