2. Introduction As a group, our older adults consume more medications than any other age group. Mostly because they have the highest prevalence of chronic problems and age-related problems.

3. Medication Consumption & Expenditures Older adults make up 13% of total population & consume more than 30% of drug expenditures. Use of prescription drug use increases with age, although the use of non-prescription drug use does not increase with age. Some people report poor health and take no meds.

4. Medication Use in Institutions This is very high. Study reported an average of 8 prescriptions per resident. This is so high because these older adults are “prescribed” over the counter meds that other people take on their own. If an institutionalized older adult is constipated, they they are prescribed a laxative. If they have a headache or back ache, they are prescribed a pain killer.

5. Factors Affecting Medication Use Physicians are encouraged to prescribe meds in many ways: pharmaceutical companies advertise in professional journals give out free samples & products offer educational seminars at resorts for physician & spouses Also, pharmaceutical companies are advertising drugs on television, radio & magazines.

6. Pharmacokinetics Study of what happens to a drug after it enters the body. how it is absorbed from the gut into the bloodstream distributed throughout the body metabolized or broken down excreted This is important to understand so we are aware of why older adults respond differently to drugs than younger people and to determine the drug dosage needed to maximize benefits and minimize side effects.

7. FDA FDA began a requirement in 1998 that all prescription drugs be labeled to include information pertinent to the use by those aged 65 and older. To be completed by 2003.

8. Changes in Drug Absorption When taken by mouth, drugs are absorbed into bloodstream from stomach or small intestine. Injected drugs enter the bloodstream directly. There are age-related changes in digestive system, but we do not believe that these changes significantly affect drug absorption. It is probably due to digestive diseases or food and other drugs taken at the same time.

9. Changes in Drug Distribution After a medication is absorbed into the bloodstream, it is carried to the body’s tissues. Some drugs dissolve in the blood and are carried that way. Others are carried by carrier proteins in the blood. Drugs may be stored in fat or muscle to be released when needed. Drugs circulate throughout body even if intended for one particular organ.

10. Changes in Drug Distribution Age-related changes cause older adults to distribute drugs differently. Many older adults weight less than younger people, so dosages may be excessive for them. Changes in body fat or body water (age-related changes) alter drug distribution. If distributed in body fluids, they are more concentrated in older adults because they have less body fluids. If stored in fatty tissues, they may last longer because older adults have more fatty tissue.

11. Changes in Drug Metabolism Liver metabolizes most medications before they are eliminated from body. Reduced liver function (age-related change) could cause medications to remain in body longer. Some believe that the liver has a great deal of reserve and age-related changes do not really affect drug metabolism.

12. Changes in Drug Excretion Most drugs are eliminated from body through the kidneys or liver. Liver breaks down some drugs and remainder is secreted into intestine with bile or released to be excreted by kidney. Some drugs leave body unchanged.

13. Changes in Drug Excretion No real change in liver excretion with age. Older adults with liver disease may need smaller doses of some drugs. Kidney function should be measured before prescribing medications that are excreted by the kidney.

14. Polypharmacy Practice of using a number of medications at the same time. Common among older adults because they often take a number of medications to treat a number of problems. Places an older adult at greater risk for adverse reactions, further health problems, increased expense of physician & hospital visits and even death.

15. Drug Interactions Unintended result of polypharmacy. Caused by: inappropriate drug dosages taking two drugs at the same time that interfere with each other ingesting alcohol or OTC medications with prescription drugs herbs can also interact with medications

16. Adverse Drug Effects Undesirable and unexpected response from the administration of a drug. Most common are gastrointestinal disturbances. Others include: confusion depression loss of appetite weakness urinary incontinence falls

17. Adverse Drug Effects Additional adverse drug effects: weight loss postural hypotension lethargy unsteady gait forgetfulness tremor constipation Many of these things seem like old age.

18. Reasons for Adverse Effects There are reasons for the vast number of problems from adverse drug effects in older adults: Smaller bodies & different body composition Decreased ability of liver to process some drugs Decreased ability of kidneys to clear drugs out of body Increased sensitivity to many drugs, especially those that act on CNS

19. Reasons for Adverse Effects Additionally: Decreased ability to maintain blood pressure stability while on some drugs making them more at risk for postural hypotension & dizziness Decreased temperature compensation (drugs reduce ability to sweat or shiver) More diseases that alter response to some drugs More drugs to take, creating more drug reactions & interactions

20. Prescription Drugs Commonly Used by Older Adults Prescription drugs are usually used to treat more serious conditions and are more likely to cause side effects. Over 5,000 prescription drugs are available. All classified into drug families or groups according to similar chemical characteristics or intended effects.

21. Antibiotics and Antivirals Antibiotics destroy disease-producing bacteria that invade body. Choice of antibiotic depends on the way it is metabolized, its method of administration, & its toxic metabolization. They are not metabolized by either they kidneys or liver. Antivirals are being developed to fight severe viral infections and to interfere with the replication of the viruses.

22. Anti-Inflammatory Drugs These medications are used to reduce joint swelling, stiffness, and pain. They are most commonly used by those with different forms of arthritis.

23. Bronchodilators and Anti- Asthmatics These drugs are used to enlarge constricted airways to make breathing easier. They are prescribed to treat those with asthma, COPD, and acute respiratory infections. Both of these come in inhalant or pill forms and sometimes cause nervousness, jitterness, increases heart rate, nausea and insomnia. Blood levels of these medications should be watched in older adults.

24. Corticosteroids Are prescribed by physicians to decrease inflammation, suppress immune reactions and promote healing. Are usually used for dermatologic conditions, COPD, auto-immune diseases, cancer, and steroid deficiency. Have many side effects and can become addictive, so they should be used as a last resort.

25. Dermatologic Drugs The main dermatologic treatment for older adults are the steroid preparations already discussed. These drugs can be applied directly to the skin or taken orally.

26. Sex Hormones Estrogen, progesterone, and testosterone are sex steroids that are widely used medications. Estrogen and progesterone are used for treatments of menopause-associated symptoms, osteoporosis and cancer. Estrogen and progesterone are also used for birth control in younger women.

27. Cholesterol-Lowering Drugs From 1978 to 1988, over half of those who were prescribed these drugs were age 60 and older. One of these drugs acts to bind bile in the gut and prevent the absorption of cholesterol. Side effects include flushing, rashes, blurred vision, constipation or abdominal distress.

28. Anti-Diabetics Oral medications act to increase the amount of insulin released from the pancreas and increase the receptivity of body cells to available insulin. Daily insulin injections are used for those who do not produce insulin. Major side effects are low blood sugar and hypoglycemia.

29. Stomach Acid Blockers Used to reduce the secretion of acid in the stomach. Those with ulcers in the stomach or duodenum, chronic heart burn, or under stress use these drugs. These drugs may cause confusion in elderly patients.

30. Psychoactive Drugs Used to treat those who suffer from migraine headaches, Parkinson’s disease, seizures, depression, anxiety, psychotic behavior, and sleep problems. More than half of the residents in nursing homes receive these drugs and older adults are more sensitive than other adults.

31. Anticonvulsives Used to prevent seizures for people with seizure disorders either developed since birth or due to other disorders.

32. Anti-Parkinsonian Agents Increase the levels of dopamine in the brain which decrease the symptoms of Parkinson’s Disease.

33. Analgesics Can be over the counter meds or prescribed. Prescribed narcotics include narcotics naturally derived from opium, or synthetic drugs. Narcotics can be prescribed for the pain of cancer, passage of a kidney stone, back strain, or migraine headaches.

34. Antipsychotics Strong tranquilizers used to treat schizophrenia or reduce agitated, disruptive behavior. Older adults are likely to receive these medications if they are mobile, incontinent, cognitively, or behaviorally disruptive.

35. Anti-Anxiety Agents Also called mild tranquilizers and are prescribed to reduce anxiety and tension, relax skeletal muscles, and facilitate alcohol withdrawal. Drugs are also useful for older adults with chronic pain.

36. Anti-Depressants Prescribed to relieve depression, reduce anxiety, or produce sedative effects. Useful for symptoms such as: insomnia, feeling low, lack of appetite and suicidal thoughts. Are more than 20 different anti-depressants on the market.

37. Cardiovascular Drugs Treat hypertension, angina, congestive heart failure, and cardiac arrhythmias. Often older adults take more than one of these medications to treat more than one of these conditions.

38. Anti-Hypertensives Diuretics are the first treatment used. Act to deplete the body of salt and water, thus reducing the water retention, lowering blood pressure.

39. Drugs for Congestive Heart Failure Diuretics are also used. In CHF, there is too much fluid in the system which overloads the heart. Diuretics decrease the amount of fluid, while these medications make the heart pump more efficiently.

40. Anti-Anginals Three major types of anti-anginals are vasodialators, calcium channel blockers, and beta blockers. These act to increase circulation to heart.

41. Anti-Coagulants Work to stop blood clotting by blocking the action of vitamin K in the liver. Drugs that decrease the clumping of platelets are also called “blood thinners.” These drugs are used in the prevention of heart attack and stroke.

42. Generic vs. Brand Name Drugs After 7 years, a drug company’s patent runs out and any company can make that drug under another brand name or a generic name. Generic drugs have the same ingredients as the brand name drug, and have to meet the same FDA regulations. Generic drugs cost 30-80% of what the brand name costs. Today there are about 2,400 generic equivalents to brand name drugs.