PHARMACOLOGY IN THE ELDERLY REFERENCES: Merck Manual Table 4 Drug-Disease Interactions in the Elderly IER NPTE Reviewer by O’Sullivan and Siegelman 2008 Pharmacology in Rehabilitation 4th ed by Ciccone

No need for students to copy and memorize these numbers No need for students to copy and memorize these numbers. This just shows the altered physiologic variables in the elderly.

POSE SPECIAL RISKS FOR ELDERLY PATIENTS Analgesics Anticoagulants Antihypertensives, Antiparkinsonian drugs Diuretics hypoglycemic drugs psychoactive drugs A list of drugs among many others that pose risks

List of risks and the medications that cause it

Risk of upper GI bleeding - NSAIDs w aspirin ASPILET BUFFERIN ECOTRIN GENACOTE or other antiplatelet drugs (clopidogrel PLAVIX). NSAIDs - increase risk of cardiovascular events and can cause fluid retention and, rarely, nephropathy; can also increase BP

COX 2 inhibitors (coxibs) – w risk of GI bleeding, especially in patients taking warfarin COUMADIN or aspirin ASPILET ECOTRIN GENACOTE (even at low dose) and in those w GI events.

Anticoagulants- risk of bleeding warfarin COUMADIN (Careful dosing and monitoring impt.) Antiparkinsonian drugs - risk of orthostatic hypotension and confusion Levodopa Because elderly patients with parkinsonism may be cognitively impaired, anticholinergic drugs should be avoided

Antihyperglycemics - risk of hypoglycemia due to sulfonylureas Chlorpropamide Psychoactive drugs - risk of tardive dyskinesia, sedation, orthostatic hypotension, anticholinergic effects, and akathisia (subjective motor restlessness) Longer-acting benzodiazepines (eg, clonazepam KLONOPIN, diazepam VALIUM, flurazepam DALMANE) should be avoided

Antihistamines (eg, diphenhydramine BENADRYL NYTOL, hydroxyzine ITERAX, VISTARIL) are not recommended as anxiolytics or hypnotics because of its anticholinergic effects.

Of antidepressants, SSRIs and mixed serotonin/ dopamine INTROPIN reuptake inhibitors are preferred than tricyclic antidepressants

Common Adverse Effects Of Drugs In The Elderly (source: IER NPTE Reviewer 2008, Chapter 8: GERIATRIC PHYSICAL THERAPY by Susan B. O'Sullivan) (1) Confusion/dementia: tranquilizers, barbiturates, digitalis, antihypertensives, anticholinergic drugs; analgesics, antiparkinsonians, diuretics, beta-blockers. (2) Sedation/immobility: e.g., psychotropic drugs, narcotic analgesics. (3) Weakness: e.g., antihypertensives, vasodilator, digitalis, diuretics, oral hypoglycemics.

(4) Postural hypotension: antihypertensives, diuretics, tricyclic antidepressants, tranquilizers, nitrates, narcotic analgesics. (5) Depression: antihypertensives, antiinflammatory, antimycobacterial, antiparkinsonians, diuretics, H2 receptor antagonists, sedative-hypnotics, vasodilators.

(6) Drug induced movement disorders. (a) Dyskinesias (involuntary, stereotypic and repetitive movements, i.e., lip smacking, hand movements, etc.) associated with long-term use of neuroleptic drugs and anticholinergic drugs, Levodopa. (b) Akathisia (motor restlessness) associated with antipsychotic drugs. (c) Essential tremor associated with tricyclic antidepressants, adrenergic drugs. (d) Parkinsonism: associated with antipsychotics, sympatholytics. (7) Incontinence: caused by or exacerbated by a variety of drugs, e.g., barbiturates, benzodiazepines, antipsychotic drugs, anticholinergic drugs.

Anticholinergic side effects include confusion, sedation, delirium, dry mouth, constipation, urinary retention, blurred vision, and worsening of narrow angle glaucoma-- reasons why patients are predisposed to falls and fractures.

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