geriatric

Overview of Metabolism in the Elderly

• Metabolism primarily occurs in the liver.
• If liver function is compromised, medication onset is delayed, leading to potential toxicity.
• Important to consider physiological changes in elderly patients.

Physiological Changes in the Elderly

• General decline in physiological functions affecting medication management.
  • Decrease in:
    • Postural hypertension
    • Excess bleeding
    • Gastrointestinal (GI) distress
• Reduction in total body water and lean body mass:
  • Leads to potential volume depletion.
• Diminished kidney function:
  • Slower excretion of medications, necessitating adjustment in dosing—specifically kidney and liver-friendly dosing.

Electolyte Changes

• Elderly patients are prone to electrolyte imbalances, particularly when on diuretics (often referred to as "water pills").
• Diuretics help eliminate excess fluid but may cause:
  • Changes in electrolytes (specifically: magnesium, potassium, sodium).

Pharmacology Considerations

• Important concepts in pharmacology:
  • Pharmacokinetics - What the body does to the drug:
    • Absorption
    • Distribution
    • Metabolism
    • Excretion
    • In the elderly, GI tract function slows, affecting absorption and distribution:
    • Reduced blood flow leads to decreased distribution of medications due to lower protein levels.
    • Proteins, essential for drug transport, may lead to toxicity if medications compete for binding.
  • Pharmacodynamics - What the drug does to the body:
    • Mechanisms may be less effective because of reduced blood volume and protein.

Drug-Receptor Interaction

• Reduced sensitivity at adrenergic receptor sites in the elderly:
  • Impact on medication efficacy due to potential lower affinity.
  • Impedicoměř reduced blood flow to the CNS, affecting how drugs function in the brain.

Polypharmacy

• Definition: The use of multiple medications by a patient, often seen in older adults due to multiple healthcare providers.
• Risks of polypharmacy include:
  • Overlapping prescriptions leading to overdose.
  • Potential interactions between drugs:
    • Agonistic drugs enhance each other's effect.
    • Antagonistic drugs may counteract each other's intended effects.
• Importance of medication reconciliation:
  • Ensure coordination among healthcare providers.
  • Reduce the risk of adverse reactions and interactions.

Understanding Medication Adherence

• Adherence to medication regimens is critical.
  • Common issues leading to non-adherence:
    • Forgetting to take medications
    • Financial constraints affecting ability to purchase drugs.
    • Misinterpreting instructions leading to dosage errors.
• Techniques for improving adherence:
  • Teaching methods (visual aids, clear instructions).
    • Ensure patients can see and hear properly during instructions.
    • Use large font for written instructions and clear coloring to avoid confusion.

Monitoring and Assessing Medication Effects

• Identifying adverse drug reactions and interactions is crucial, particularly in the elderly:
  • Symptoms such as changes in consciousness, behavior, or overmedication require immediate attention.
  • Regular assessments for side effects versus adverse effects:
    • Adverse effects may require discontinuation of medication.

Questions on Physiological Changes

• Key physiological changes that affect drug administration in older adults include:
  • Increased fat-to-water ratio.
  • Decreased enzyme production.
  • Loss of nephrons.
  • Decreased gastrointestinal blood flow.
• The assessment of renal function is crucial:
  • Common lab values to monitor include:
    • Glomerular filtration rate (GFR).

Conclusion

• Effective pharmacological care for elderly patients requires understanding age-related physiological changes, the principles of polypharmacy, and diligent monitoring of medication adherence. Integration of teaching, individual assessment, and tailored medication regimens is essential for optimizing health outcomes.