![Page 1: Pharmacologic in the Geriatric Population 1. Do you have a Pharm Dictionary? y.html](https://reader036.vdocuments.net/reader036/viewer/2022062800/56649e015503460f94aeb2b6/html5/thumbnails/1.jpg)
Pharmacologic in the Geriatric Population
1
![Page 2: Pharmacologic in the Geriatric Population 1. Do you have a Pharm Dictionary? y.html](https://reader036.vdocuments.net/reader036/viewer/2022062800/56649e015503460f94aeb2b6/html5/thumbnails/2.jpg)
Do you have a Pharm Dictionary?
• www.nlm.nih.gov/medlineplus/mplusdictionary.html
![Page 3: Pharmacologic in the Geriatric Population 1. Do you have a Pharm Dictionary? y.html](https://reader036.vdocuments.net/reader036/viewer/2022062800/56649e015503460f94aeb2b6/html5/thumbnails/3.jpg)
Issues for the Geriatric Population
• Pattern of drug use • Altered response to drug therapy• Multiple disease states• Lack of proper drug testing• Problems with drug education and
compliance (Health Literacy)• Financial issues impacting medication usage
![Page 4: Pharmacologic in the Geriatric Population 1. Do you have a Pharm Dictionary? y.html](https://reader036.vdocuments.net/reader036/viewer/2022062800/56649e015503460f94aeb2b6/html5/thumbnails/4.jpg)
Other Factors in Geriatric Drug Use
• Presence of Multiple Chronic Conditions o 80% of those 65+ have multiple diseases with
medications
4
Comorbidities More drugsIncrease risk of drug-drug interactions
![Page 5: Pharmacologic in the Geriatric Population 1. Do you have a Pharm Dictionary? y.html](https://reader036.vdocuments.net/reader036/viewer/2022062800/56649e015503460f94aeb2b6/html5/thumbnails/5.jpg)
Commonly prescribed meds related to ED admissions among elderly
• From 2007 to 2009, 99,628 “emergency” hospitalizations of patients > 65 years of age occurred due to adverse drug eventso 66% being attributed to unintentional drug overdoseo 48% of the hospitalizations involving those > 80 years
of age
• 4 drugs were implicated in 67% of patientso Warfarin (33.3%)o Insulin (13.9%)o Anti-platelet agents (13.3%)o Oral hypoglycemic agents (10.7%)
![Page 7: Pharmacologic in the Geriatric Population 1. Do you have a Pharm Dictionary? y.html](https://reader036.vdocuments.net/reader036/viewer/2022062800/56649e015503460f94aeb2b6/html5/thumbnails/7.jpg)
Altered Response to Drugs
• Pharmacokinetic Changes in the Body (The way in which one drug moves throughout the body)o Absorptiono Metabolismo Distributiono Excretion
7
![Page 8: Pharmacologic in the Geriatric Population 1. Do you have a Pharm Dictionary? y.html](https://reader036.vdocuments.net/reader036/viewer/2022062800/56649e015503460f94aeb2b6/html5/thumbnails/8.jpg)
Pharmacokinetic change
• Absorptiono Altered GI function in elderly due to
Decrease gastric acid Decrease stomach emptying Decrease absorption area Decrease motility Sometimes decreased H2O intake
8
![Page 9: Pharmacologic in the Geriatric Population 1. Do you have a Pharm Dictionary? y.html](https://reader036.vdocuments.net/reader036/viewer/2022062800/56649e015503460f94aeb2b6/html5/thumbnails/9.jpg)
Pharmacokinetic change
• Metabolismo The process to inactivate drugs and create
water-soluble by-products (metabolites) that can be excreted by the kidneys.
o Primarily takes place at liver
• Interference with metabolism oMAO inhibitors (e.g. Selegiline) have lots of
contraindications and drug interactions o Vitamin K with Coumadino Vitamin B with Levodopa9
![Page 10: Pharmacologic in the Geriatric Population 1. Do you have a Pharm Dictionary? y.html](https://reader036.vdocuments.net/reader036/viewer/2022062800/56649e015503460f94aeb2b6/html5/thumbnails/10.jpg)
Pharmacokinetic change
• Hepatic Metabolism o Decrease liver mass
o Decrease liver blood flow
o Decrease enzyme activity
Leads to decreased liver metabolism
o Injury to liver (trauma, CA, ETOH also impact the liver metabolism)
10
![Page 11: Pharmacologic in the Geriatric Population 1. Do you have a Pharm Dictionary? y.html](https://reader036.vdocuments.net/reader036/viewer/2022062800/56649e015503460f94aeb2b6/html5/thumbnails/11.jpg)
Pharmacokinetic change
• Distributiono Decrease in body water content
o Increase in body fat
o Decrease in lean body mass
o Decrease in plasma proteins
e.g. aspirin or warfarin may produce a greater response because there will be less drug bound to
o Drugs are area specific - either bind to receptors or act on tissues in order to be effective, e.g. water-soluble, fat soluble, protein affinity
11
![Page 12: Pharmacologic in the Geriatric Population 1. Do you have a Pharm Dictionary? y.html](https://reader036.vdocuments.net/reader036/viewer/2022062800/56649e015503460f94aeb2b6/html5/thumbnails/12.jpg)
Pharmacokinetic change
• Excretiono Primarily takes place at kidneyo Kidney filters the drug from the circulation and
excrete it from the body via the urineoDecreased Renal functioning with age
Decrease kidney mass Decrease renal blood flow Decrease in tubular function in the nephron
oResults in? Build up/Accumulation of drug
12
![Page 13: Pharmacologic in the Geriatric Population 1. Do you have a Pharm Dictionary? y.html](https://reader036.vdocuments.net/reader036/viewer/2022062800/56649e015503460f94aeb2b6/html5/thumbnails/13.jpg)
Pharmacodynamic Interactions
• The way in which one drug’s action interferes with the action of the other
• Pharmacologic antagonism• Physiologic antagonism• Synergism
![Page 14: Pharmacologic in the Geriatric Population 1. Do you have a Pharm Dictionary? y.html](https://reader036.vdocuments.net/reader036/viewer/2022062800/56649e015503460f94aeb2b6/html5/thumbnails/14.jpg)
Pharmacodynamic Changes
![Page 15: Pharmacologic in the Geriatric Population 1. Do you have a Pharm Dictionary? y.html](https://reader036.vdocuments.net/reader036/viewer/2022062800/56649e015503460f94aeb2b6/html5/thumbnails/15.jpg)
Pharmacodynamic Changes
• Systemic drug response altered due to physiological changes in the elderly
• Each patient is different in his response to medications
• Altered response may occur with alterations in drug-receptor attraction which can increase or decrease sensitivity
15
![Page 16: Pharmacologic in the Geriatric Population 1. Do you have a Pharm Dictionary? y.html](https://reader036.vdocuments.net/reader036/viewer/2022062800/56649e015503460f94aeb2b6/html5/thumbnails/16.jpg)
Pharmacodynamic Changes
• There are changes in receptor linkage or coupling to the cell that occurs in certain tissues as a function of aging.
• In some patients the biological response of a medication may be blunted due to changes in cellular structure and function that occur in the elderly.
• ½ life longer with aging adult
![Page 17: Pharmacologic in the Geriatric Population 1. Do you have a Pharm Dictionary? y.html](https://reader036.vdocuments.net/reader036/viewer/2022062800/56649e015503460f94aeb2b6/html5/thumbnails/17.jpg)
OTC drug use in Geriatrics
• >60 y.o. 40% use OTC every day
• Used for pain (OA), digestive purposes (laxative), decongestants (sometimes alcohol based)
• 80% take with alcohol, Rx drugs or both
• Use of alternative meds and treatmento can alter PT/PTT times, absorption
17
![Page 18: Pharmacologic in the Geriatric Population 1. Do you have a Pharm Dictionary? y.html](https://reader036.vdocuments.net/reader036/viewer/2022062800/56649e015503460f94aeb2b6/html5/thumbnails/18.jpg)
Psychotropic Drugs
• Sedative Hypnotic?
• Antianxiety Agents?
• Antidepressant Meds?
• Antipsychotic Medso Haloperidol (Haldol)
18
![Page 19: Pharmacologic in the Geriatric Population 1. Do you have a Pharm Dictionary? y.html](https://reader036.vdocuments.net/reader036/viewer/2022062800/56649e015503460f94aeb2b6/html5/thumbnails/19.jpg)
Sedative Hypnotics
• Benzodiazepineo Primary drugs used to promote sleep and
decrease anxiety in older adultso Increase central inhibitory effect of GABAo Temazepam (Restoril)o Side effects
“hangover”, drowsiness and sluggish, anterograde amnesia (short-term memory for the period immediately preceding drug administration, rebound insomnia
![Page 20: Pharmacologic in the Geriatric Population 1. Do you have a Pharm Dictionary? y.html](https://reader036.vdocuments.net/reader036/viewer/2022062800/56649e015503460f94aeb2b6/html5/thumbnails/20.jpg)
Anti-Anxiety Meds
• Decrease agitation• Drugs directly stimulating serotonin receptors
in certain parts of the brain (dorsal raphe nucleus)
• Benzodiazepine o Diazepam (Valium)o Lorezepam (Ativan)
• Azapironeso Buspirone (BuSpar)=“Busy” drug decreases to help
anxiety20
![Page 21: Pharmacologic in the Geriatric Population 1. Do you have a Pharm Dictionary? y.html](https://reader036.vdocuments.net/reader036/viewer/2022062800/56649e015503460f94aeb2b6/html5/thumbnails/21.jpg)
Antidepressant
• Increase synaptic transmission in CNS pathways that utilize norepinephrine, dopamine, or serotonin=same pathway
• Tricyclico Amitriptyline (Elavil)=“elevate your mood”
o Produce anticholinergic (Ach) effects
dry mouth, constipation, urinary retention, and CNS symptoms such as confusion, cognitive impairment, and delirium. (frontal lobe)
21
![Page 22: Pharmacologic in the Geriatric Population 1. Do you have a Pharm Dictionary? y.html](https://reader036.vdocuments.net/reader036/viewer/2022062800/56649e015503460f94aeb2b6/html5/thumbnails/22.jpg)
Antidepressant
• MAO inhibitorso Isocarboxazid (Marplan)
o Causes orthostatic hypotension, insomnia.
• 2nd generation (SSRI)o Bupropion (Wellbutrin)
o Fluoxetine (Prozac)
o Causes GI irritation and bleeding
o May take anywhere from 1 to 6 weeks to take effect22
![Page 23: Pharmacologic in the Geriatric Population 1. Do you have a Pharm Dictionary? y.html](https://reader036.vdocuments.net/reader036/viewer/2022062800/56649e015503460f94aeb2b6/html5/thumbnails/23.jpg)
23
![Page 24: Pharmacologic in the Geriatric Population 1. Do you have a Pharm Dictionary? y.html](https://reader036.vdocuments.net/reader036/viewer/2022062800/56649e015503460f94aeb2b6/html5/thumbnails/24.jpg)
Sinemet (Carbidopa/Levodopa)
Effective for mild to moderate Parkinson’sNot effective for end stage.
• GI problems o Nausea, vomiting
• Cardiovascular problems o Arrythmia, orthostasis
• Neuropsychiatric problems o Confusion, depression, anxiety, hallucination
• On and OFF phenomenon• End of dose akinesia24
![Page 25: Pharmacologic in the Geriatric Population 1. Do you have a Pharm Dictionary? y.html](https://reader036.vdocuments.net/reader036/viewer/2022062800/56649e015503460f94aeb2b6/html5/thumbnails/25.jpg)
FDA Warning about Stalevo (Carbidopa + Levodopa + Entacapone)
• [Posted 08/20/2010] Issue: FDA notified healthcare professionals that it is evaluating clinical trial data that suggest patients taking Stalevo (a combination of carbidopa/levodopa and entacapone) may be at an increased risk for cardiovascular events (heart attack, stroke, and cardiovascular death) compared to those taking carbidopa/levodopa (sold as the combination product, Sinemet). http://www.nlm.nih.gov/medlineplus/druginfo/meds/a601068.html
![Page 26: Pharmacologic in the Geriatric Population 1. Do you have a Pharm Dictionary? y.html](https://reader036.vdocuments.net/reader036/viewer/2022062800/56649e015503460f94aeb2b6/html5/thumbnails/26.jpg)
Sinemet (Carbidopa/Levodopa) formulation
• Coordinate patient care time at the peak effects of drug
Carbidopa/Levodopa Time-to-peak concentration
Effective Duration
Immediate Release10/100, 25/100, 25/250Usually 3 or 4 times a day
30 min 2-4 hr
Controlled Release (CR)25/100, 50/200Usually 2 or 4 times a day
2 hours 4-6 hr
Parcopa (orally disintegrating tablet) 10/100, 25/100, 25/250Usually 3 or 4 times a day
30 min 1/2-1 hr
![Page 27: Pharmacologic in the Geriatric Population 1. Do you have a Pharm Dictionary? y.html](https://reader036.vdocuments.net/reader036/viewer/2022062800/56649e015503460f94aeb2b6/html5/thumbnails/27.jpg)
Sinemet (Carbidopa/Levodopa)
• The peak concentrations of levodopa after a single dose of Sinemet CR 50/200 increased by 25% when administered with food.
• Vitamin B 6 can reduce the effects of levodopa when levodopa is taken by itself.
• Large amounts of Vitamin B 6 are also contained in some foods, such as bananas, egg yolks, lima beans, meats, peanuts, and whole grain cereals. Patient should limit the amount of these goods while on Sinemet.
![Page 28: Pharmacologic in the Geriatric Population 1. Do you have a Pharm Dictionary? y.html](https://reader036.vdocuments.net/reader036/viewer/2022062800/56649e015503460f94aeb2b6/html5/thumbnails/28.jpg)
Pain and inflammation medications
• Opiod Analgesics (aka Narcotics)oMorphine, Demoral, CodeineoChanges the pain perception but not painful
stimuluso ADR: sedation, mood changes, nausea,
vomiting, constipation, orthostatic hypotension, respiratory depression, drug addiction
![Page 29: Pharmacologic in the Geriatric Population 1. Do you have a Pharm Dictionary? y.html](https://reader036.vdocuments.net/reader036/viewer/2022062800/56649e015503460f94aeb2b6/html5/thumbnails/29.jpg)
Administration of morphine in the periaqueductal gray and serotonin (5-HT) in the Raphe nucleus produces analgesia.
Fig 8.3B. neuroscience.uth.tmc.edu/s2/chapter08. html
![Page 30: Pharmacologic in the Geriatric Population 1. Do you have a Pharm Dictionary? y.html](https://reader036.vdocuments.net/reader036/viewer/2022062800/56649e015503460f94aeb2b6/html5/thumbnails/30.jpg)
Pain and inflammation medications
• NSAIDso Anagelsic, decrease inflammation and fever,
anticoagulanto ADR: GI bleeding, renal and liver problems,
impair bone healing• Acetaminophen
o Analgesic, decrease fevero ADR: more toxic to liver than NSAIDs
• NSAIDS and Acetaminophen inhibit the synthesis of prostaglandins at different sites.
![Page 31: Pharmacologic in the Geriatric Population 1. Do you have a Pharm Dictionary? y.html](https://reader036.vdocuments.net/reader036/viewer/2022062800/56649e015503460f94aeb2b6/html5/thumbnails/31.jpg)
Peripheral sensitization after an injury
Fig 5.2 Harrison's Neurology in Clinical Medicine, 2010
![Page 32: Pharmacologic in the Geriatric Population 1. Do you have a Pharm Dictionary? y.html](https://reader036.vdocuments.net/reader036/viewer/2022062800/56649e015503460f94aeb2b6/html5/thumbnails/32.jpg)
Pain and inflammation medications
• COX-2 inhibitor (Celebrex)o Inhibit the production of harmful
prostaglandinso ADR: GI problems, cardiovascular problems
such as MI and stroke (therefore VIOXX was removed from the market)
![Page 33: Pharmacologic in the Geriatric Population 1. Do you have a Pharm Dictionary? y.html](https://reader036.vdocuments.net/reader036/viewer/2022062800/56649e015503460f94aeb2b6/html5/thumbnails/33.jpg)
Pain and inflammation medications
• Glucocorticoidso Anti-inflammatory (suppressing leukocyte and
inhibit proinflammatory substances such as cytokines and prostaglandins)
o ADR: HTN, peptic ulcer, aggravating DM, glaucoma, increased risk of infection, inhibit corticosteroids production by adrenal cortex
oGlucocorticoids produce a general catabolic=destroyer effect throughout the body, breaking down bones, ligaments, tendons, skin and muscles
![Page 34: Pharmacologic in the Geriatric Population 1. Do you have a Pharm Dictionary? y.html](https://reader036.vdocuments.net/reader036/viewer/2022062800/56649e015503460f94aeb2b6/html5/thumbnails/34.jpg)
Cardiac Meds
• Table 4-5
34
![Page 35: Pharmacologic in the Geriatric Population 1. Do you have a Pharm Dictionary? y.html](https://reader036.vdocuments.net/reader036/viewer/2022062800/56649e015503460f94aeb2b6/html5/thumbnails/35.jpg)
Drugs in geriatric hypertension
• Current normal BP thresholds o Systolic/Diastolic BP < 140/90 mmHg in older adultso Systolic/Diastolic BP < 130/80 mmHg in older adults
with comorbidities, e.g chronic renal insufficiency or diabetes mellitus
o Hypertension T(x) Meds: B-blockers, Diuretics,
![Page 36: Pharmacologic in the Geriatric Population 1. Do you have a Pharm Dictionary? y.html](https://reader036.vdocuments.net/reader036/viewer/2022062800/56649e015503460f94aeb2b6/html5/thumbnails/36.jpg)
β-blockers, α-blockers (sympatholytic agents)
• Reduce excessive sympathetic stimulation of the heart and peripheral vessels to decrease HR and myocardial contraction forceo blocking epinephrine & norepinepherine
• Indications of β-blockers:o HTN: Atenolol (Tenormin)o Angina: Metoprolol (Lopressor)o Arrthmias: Nadolol (Corgard)o CHF
• β-blockers cause hypotension, dizziness, syncope36
![Page 37: Pharmacologic in the Geriatric Population 1. Do you have a Pharm Dictionary? y.html](https://reader036.vdocuments.net/reader036/viewer/2022062800/56649e015503460f94aeb2b6/html5/thumbnails/37.jpg)
Diuretics
37
Act on kidneys to increase the excretion of H2O sodium
Decrease the volume of fluid and thus cardiac workload
Volume depletion can lead to hyponatremia & hypokalemia
![Page 38: Pharmacologic in the Geriatric Population 1. Do you have a Pharm Dictionary? y.html](https://reader036.vdocuments.net/reader036/viewer/2022062800/56649e015503460f94aeb2b6/html5/thumbnails/38.jpg)
Diuretics
• Indications: CHF, Hypertension, edema• Loop diuretic: Furosemide (Lasix)• Thiazide diuretic: Chlorothiazide (Diruil)• Potassium sparing diuretic: Spironolactone
(Aldactone)• ADR: confusion, weakness, fatigue, increase
urinary output (annoying side effects)• Common drug regimen
o Diuretics + β-blockero Diuretics + ACE inhibitor38
![Page 39: Pharmacologic in the Geriatric Population 1. Do you have a Pharm Dictionary? y.html](https://reader036.vdocuments.net/reader036/viewer/2022062800/56649e015503460f94aeb2b6/html5/thumbnails/39.jpg)
Angina pectoris (chest pain – a symptom of coronary artery disease)
39
Angina occurs when Myocardial O2 demand> Myocardial O2 supply
Nitrates cause vasodilation of the peripheral vasculature
Decreases Cardiac Preload (the amount of blood returning to the heart)
Decrease cardiac Afterload (the pressure in the vasculature)
Temporarily reduce cardiac workload and O2 demand
![Page 40: Pharmacologic in the Geriatric Population 1. Do you have a Pharm Dictionary? y.html](https://reader036.vdocuments.net/reader036/viewer/2022062800/56649e015503460f94aeb2b6/html5/thumbnails/40.jpg)
Organic Nitrates
• Indications of organic nitrateso Angina pectoris: Nitroglycerin (nitrostat)
• Sublingual or transdermal by a patch• ADR: decreased BP, orthostatic hypotension,
dizziness
40
![Page 41: Pharmacologic in the Geriatric Population 1. Do you have a Pharm Dictionary? y.html](https://reader036.vdocuments.net/reader036/viewer/2022062800/56649e015503460f94aeb2b6/html5/thumbnails/41.jpg)
ACE Inhibitors (angiotensin-converting enzyme)
• Block the conversion of Angiotensin 1 to Angiotensin 2 (a vasoconstrictor) and thus decrease the pressure in peripheral vasculature the heart pump against
• Indicationso HTN: Captopril (Capoten)o CHF: Enalapril (Vasotec)
• ADR: hypotension, orthostatic hypotension• Common drug regimen
o ACE inhibitor + Calcium blocker 41
![Page 42: Pharmacologic in the Geriatric Population 1. Do you have a Pharm Dictionary? y.html](https://reader036.vdocuments.net/reader036/viewer/2022062800/56649e015503460f94aeb2b6/html5/thumbnails/42.jpg)
42
![Page 43: Pharmacologic in the Geriatric Population 1. Do you have a Pharm Dictionary? y.html](https://reader036.vdocuments.net/reader036/viewer/2022062800/56649e015503460f94aeb2b6/html5/thumbnails/43.jpg)
Anti-Arrhythmic Medications
• Sodium Channel Blockerso Lidocaine (Xylocaine)o Stabilize opening/closing membrane Na2+ channels
to control myocardial excitability
• β-Blockers o Nadolol (Corgard)o Prolong the duration of cardiac repolarization
• Calcium Channel Blockerso Diltiazem (Cardizem)o Decrease myocardial excitability by limiting entry of
Ca2+ into cardiac muscles
![Page 44: Pharmacologic in the Geriatric Population 1. Do you have a Pharm Dictionary? y.html](https://reader036.vdocuments.net/reader036/viewer/2022062800/56649e015503460f94aeb2b6/html5/thumbnails/44.jpg)
Pattern of Drug Use in the Elderly
• PolypharmacyoDrug regime of a patient contains one or more
“unnecessary” medications (both OTC and Rx meds)
• Administration of drugs to treat an illness creates an adverse reaction, drug side effects seen as new symptoms. Therefore, more drugs are administered.
![Page 45: Pharmacologic in the Geriatric Population 1. Do you have a Pharm Dictionary? y.html](https://reader036.vdocuments.net/reader036/viewer/2022062800/56649e015503460f94aeb2b6/html5/thumbnails/45.jpg)
Characteristics of Polypharmacy
• Use medication for no apparent reason
• Use of duplicate medications
• Use of concurrent interacting medications
• Use of contraindicated medications
• Use of inappropriate drugs
• Use of drug therapy to treat adverse drug reactions
• Patient improves when meds are discontinued
![Page 46: Pharmacologic in the Geriatric Population 1. Do you have a Pharm Dictionary? y.html](https://reader036.vdocuments.net/reader036/viewer/2022062800/56649e015503460f94aeb2b6/html5/thumbnails/46.jpg)
Prevention of Polypharmacy
• Drug regime reviewed periodicallyoWritten list, One pharmacy, Primary Care
Physician
• Unnecessary or harmful drugs are discontinuedoHave family member discard expired drugs
• New drugs added only if truly needed
46
![Page 47: Pharmacologic in the Geriatric Population 1. Do you have a Pharm Dictionary? y.html](https://reader036.vdocuments.net/reader036/viewer/2022062800/56649e015503460f94aeb2b6/html5/thumbnails/47.jpg)
Prevention of Polypharmacy
• Communication between various physicians
• PT’s can assist by recognizing changes in patient’s response to drugso Identify changes as drug reactions rather than
new symptomsoHave patient bring a list to therapy oChart review
47
![Page 48: Pharmacologic in the Geriatric Population 1. Do you have a Pharm Dictionary? y.html](https://reader036.vdocuments.net/reader036/viewer/2022062800/56649e015503460f94aeb2b6/html5/thumbnails/48.jpg)
Common Adverse Drug Reactions (ADR)
• GI problemsomust adjust dose and type of medication to
minimize problems
• Sedationomany drugs will increase sedative properties
in the elderly
• Confusionomay increase in patients already confused
48
![Page 49: Pharmacologic in the Geriatric Population 1. Do you have a Pharm Dictionary? y.html](https://reader036.vdocuments.net/reader036/viewer/2022062800/56649e015503460f94aeb2b6/html5/thumbnails/49.jpg)
Other adverse drug reactions
• Depression • Orthostatic Hypotension • Fatigue and Weakness• Dizziness and Falls• Extrapyramidal symptoms (dyskinesia)• Anticholinergic Effects
o CNS effects with confusion, nervousness, drowsiness, dizziness
o Dry mouth, constipation, urinary retention, tachycardia, blurred vision
49
![Page 50: Pharmacologic in the Geriatric Population 1. Do you have a Pharm Dictionary? y.html](https://reader036.vdocuments.net/reader036/viewer/2022062800/56649e015503460f94aeb2b6/html5/thumbnails/50.jpg)
Lack of Proper Drug Testing in the Geriatric Population
• Evaluation of drugs in geriatric patients may not have occurred prior to FDA approval
• In 1997, FDA established the Geriatric Use Subsection to provide guidance for labelingoHealthy People 2010: polypharmacy as a part
of the safety issues (2020 as well)
50
![Page 51: Pharmacologic in the Geriatric Population 1. Do you have a Pharm Dictionary? y.html](https://reader036.vdocuments.net/reader036/viewer/2022062800/56649e015503460f94aeb2b6/html5/thumbnails/51.jpg)
Societal Issues with Geriatric pharmacy
• Somewhat recent ventureo Falls & behavioral changes were considered
normal
• Currently FDA only requires safety & efficacy for the target area of the drug for those 20-60 y.o.
• The impact on advertisingo Just because it is FDA approved and on TV, is
it safe and effective?51
![Page 52: Pharmacologic in the Geriatric Population 1. Do you have a Pharm Dictionary? y.html](https://reader036.vdocuments.net/reader036/viewer/2022062800/56649e015503460f94aeb2b6/html5/thumbnails/52.jpg)
Compliance issues
1. Number of medications
2. Inadequate information or instructions
3. Cultural background
4. Social isolation
5. Duration of drug treatment
6. Cost
7. Limitations of illness (physical & mental)
52
![Page 53: Pharmacologic in the Geriatric Population 1. Do you have a Pharm Dictionary? y.html](https://reader036.vdocuments.net/reader036/viewer/2022062800/56649e015503460f94aeb2b6/html5/thumbnails/53.jpg)
Patient education and self-adherence to drug therapy issues
• Many drugs are over prescribed and misused in older adults
• Drugs aren’t always taken as directed
• Decline in cognitive function, poor eyesight
• Drug Costs
53
![Page 54: Pharmacologic in the Geriatric Population 1. Do you have a Pharm Dictionary? y.html](https://reader036.vdocuments.net/reader036/viewer/2022062800/56649e015503460f94aeb2b6/html5/thumbnails/54.jpg)
Physical Therapy Implications
• Distinguishing Drug effects from Symptoms
• Scheduling Physical Therapy Sessions around Dosage Schedule
• Promote a synergistic relationship between drugs and physical therapy interventions
54
![Page 55: Pharmacologic in the Geriatric Population 1. Do you have a Pharm Dictionary? y.html](https://reader036.vdocuments.net/reader036/viewer/2022062800/56649e015503460f94aeb2b6/html5/thumbnails/55.jpg)
Physical Therapy Implications
• Avoid harmful interactions between PT procedures and Drug Effects
• Improving Education and Compliance with Drug Therapy in the Elderly
55