Page 1080 - Basic _ Clinical Pharmacology ( PDFDrive )

1066 SECTION X Special Topics

The disappearance of symptoms is often regarded as the best rea- Ancolli-Israel S, Ayalon L: Diagnosis and treatment of sleep disorders in older
son to halt drug taking, especially if the prescription was expensive. adults. Am J Geriatr Psychiatry 2006;14:95.
Nonadherence may also be deliberate. A decision not to take Aronow WS: Drug treatment of systolic and diastolic heart failure in elderly
persons. J Gerontol A Biol Med Sci 2005;60:1597.
a drug may be based on prior experience with it. There may Blackburn EH, Epel ES, Liu J: Human telomere biology: A contributory and
be excellent reasons for such “intelligent” noncompliance, and interactive factor in aging, disease risks, and protection. Science 2015;
the practitioner should try to elicit them. Such efforts may also 350:1193.
improve compliance with alternative drug regimens, because Calcado RT, Young NS: Telomere diseases. N Engl J Med 2009;361:2353.
enlisting the patient as a participant in therapeutic decisions Chatap G, Giraud K, Vincent JP: Atrial fibrillation in the elderly: Facts and
management. Drugs Aging 2002;19:819.
increases the motivation to succeed. Cockcroft DW, Gault MH: Prediction of creatinine clearance from serum
Some errors in drug taking are caused by physical disabilities. creatinine. Nephron 1976;16:31.
Arthritis, tremor, and visual problems may all contribute. Liquid Dergal JM et al: Potential interactions between herbal medicines and conventional
medications that are to be measured “by the spoonful” are espe- drug therapies used by older adults attending a memory clinic. Drugs Aging
2002;19:879.
cially inappropriate for patients with any type of tremor or motor Docherty JR: Age-related changes in adrenergic neuroeffector transmission. Auton
disability. Use of a dosing syringe is essential in such cases. Because Neurosci 2002;96:8.
of decreased production of saliva, older patients often have dif- Drugs for cognitive loss and dementia. Treat Guidel Med Lett 2013;11:95.
ficulty swallowing large tablets. “Childproof” containers are often Epstein NU et al: Medication for Alzheimer’s disease and associated fall hazard:
“elder-proof” if the patient has arthritis. Cataracts and macular A retrospective cohort study from the Alzheimer’s disease neuroimaging
initiative. Drugs Aging 2014;31:125.
degeneration occur in a large number of patients over 70. There- Ferrari AU: Modifications of the cardiovascular system with aging. Am J Geriatr
fore, labels on prescription bottles should be large enough for the Cardiol 2002;11:30.
patient with diminished vision to read or should be color-coded Gandy S: Lifelong management of amyloid-beta metabolism to prevent Alzheimer’s
if the patient can see but can no longer read. Because of impaired disease. N Engl J Med 2012;367:864.
hearing, even carefully delivered instructions regarding drug use Guarente L: Sirtuins, aging, and medicine. N Engl J Med 2011;364:2235.
may not be understood by the patient; written instructions may Hubbard BP, Sinclair DA: Small molecule SIRT1 activators for the treatment of
aging and age-related diseases. Trends Pharmacol Sci 2014;35:146.
be helpful. Jager RD, Mieler WF, Miller JW: Age-related macular degeneration. N Engl J Med
Drug therapy has considerable potential for both helpful and 2008;358:2606.
harmful effects in the geriatric patient. The balance may be tipped Japp D et al: Mineralocorticoid receptor antagonists in elderly patients with
in the right direction by adherence to a few principles: heart failure: a systematic review and meta-analysis. Age Ageing 2017;
46:18.
1. Take a careful drug history. The disease to be treated may be Kelly AS, Morrison RS: Palliative care for the seriously ill. N Engl J Med
2015;373:747.
drug-induced, or drugs being taken may lead to interactions Kennedy BK, Pennypacker JK: Drugs that modulate aging: the promising yet
with drugs to be prescribed. difficult path ahead. Translat Res 2013;163:1.
2. Prescribe only for a specific and rational indication. Do not Kirby J et al: A systematic review of the clinical and cost-effectiveness of meman-
prescribe omeprazole for “dyspepsia.” Expert guidelines are tine in patients with moderately severe to severe Alzheimer’s disease. Drugs
Aging 2006;23:227.
published regularly by national organizations and websites such Lachs MS, Pillemer KA: Elder abuse. N Engl J Med 2015;373:1947.
as UpToDate.com. Lamming DW et al: Rapamycin-induced insulin resistance is mediated by
3. Define the goal of drug therapy. Then start with small doses mTORC2 loss and uncoupled from longevity. Science 2012;335:1638.
and titrate to the response desired. Wait at least three half-lives Langa KM et al: A comparison of the prevalence of dementia in the United States
in 2000 and 2012. JAMA Intern Med 2017;177:51.
(adjusted for age) before increasing the dose. If the expected Levey AS et al: Using standardized serum creatinine values in the modification of
response does not occur at the normal adult dosage, check diet in renal disease study equation for estimating glomerular filtration rate.
blood levels. If the expected response does not occur at the Ann Int Med 2006;145:247.
appropriate blood level, switch to a different drug. Lipska KJ et al: Polypharmacy in the aging patient. A review of glycemic control in
older adults with type 2 diabetes. JAMA 2016;315:1034.
4. Maintain a high index of suspicion regarding drug reactions Mangoni AA: Cardiovascular drug therapy in elderly patients: Specific age-related
and interactions. Know what other drugs the patient is taking, pharmacokinetic, pharmacodynamic and therapeutic considerations. Drugs
including over-the-counter and botanical (herbal) drugs. Aging 2005;22:913.
5. Simplify the regimen as much as possible. When multiple Moreno JA et al: Oral treatment targeting the unfolded protein response prevents
neurodegeneration and clinical disease in prion-infected mice. Sci Transl
drugs are prescribed, try to use drugs that can be taken at the Med 2013;5:206ra138.
same time of day. Whenever possible, reduce the number of Morrison LJ, Morrison RS: Palliative care and pain management. Med Clin N
drugs being taken. Am 2006;90:983.
Palmer AM: Neuroprotective therapeutics for Alzheimer’s disease: Progress and
prospects. Trends Pharmacol Sci 2011;32:141.
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