Please enable JavaScript.
Coggle requires JavaScript to display documents.
Aging, Drugs, Polypharmacy - Coggle Diagram
Aging, Drugs, Polypharmacy
Changes in Pharmacokinetics/Pharmacodynamics
Pharmacokinetics: Effects of body on meds
Altered
Absorption: Decreased bioavailability
Distribution: Increase body fat ( High serum level and longer half-life)
Higher serum level of water soluble drugs, and increased fat soluble drugs half-life
Metabolism: Decrease oxidative metabolism
Changes in first pass effect
Excretion: Decrease kidney function (Prolonged half-life)
GFR normally decreases with age, calculation of creatinine clearance
Pharmacodynamics: Effect of medication on body
Altered
Changes in receptor numbers, post-receptor mechanisms, impaired homeostatic mechanisms, increasing comorbidity
Potential Issues of polypharmacy
Most Common Substances
NSAIDs, Anticholinergics, Natural Products, CNS depressants
Adverse Drug Reactions
Drug Disease Interactions
Parkinsons and Psychoactive drugs -> Confusion
NSAIDs exacerbates congestive heart failure
Benign prostatic hypertrophy and decongestants or anticholinergics -> Increase urinary retention
Principles of Polypharmacy
Medication Review
Complete drug history, review each medication, and use impartial resources
Rational Prescribing
Type of benefit, extent of benefit, quality of evidence, time benefit
Type of harm, extent of harm, quality of evidence, time to toxicity
Convenience in geriatrics is highly influenced by factors: Personal goals, cognition, vision, dexterity, monitoring
Impartial Resources
Navigate efficiently (Lexi-comp, micromedex, RxTx)
ARMOR Tool
Assess
Potentially Inappropriate Medications
Anticholinergics: Antihcholinergics
CV: Alpha 1 blockers for hypertension
Afib, HF: Digoxin
CNS: Antidepressants alone or in combination
Benzos
Often prescribed for insomnia/anxiety and can be linked to falls
Diabetes: Sunfonylureas (long acting)
NSAIDS: Non Cox selective NSAIDs
Heart Failure: NSAIDs/ COX-2 inhibitors
Syncope: Acetylcholinesterases
History of falls: Anti epileptics, Antipsychotics, Antidepressants
Review
Look for possible interactions, and impacts on functional status
Minimize
Minimized non-essential medications, and eliminate medications that lack evidence for use/benefit outeweigh risks
Optimize
Address duplication, redundancy, and adjust renally cleared medications, simplify medication regime
Reassess
Reassess functional status, cognitive status, clinical status, and medication compliance
Medication and Cognitive impairment
Common cause of potentially reversible cognitive impairment
Patients with dementia are exposed to medication-induced delirium (Benzodiazepines)