Aging and Drugs

Bjerrum L, Sogaard J, Hallas J et al. (1998) Polypharmacy correlations with sex, age and drug regimen. A prescription database study. Eur J Clin Pharmacol 54(3) 197-202... 

What associations can there be between falls in old age and drugs During the last decades, a number of scientific studies have been performed to examine if there are associations or not (Blalock et al. 2005, Leipzig et al. 1999a,b). Several of these studies have shown that many different kinds of drugs increase the numbers of falls and especially in people 65 years or older. These falls can lead to both physical injuries and mental health problems in elderly with consequences for a long time afterwards. 

Sustained-release formulations can produce stable serum concentrations with once or twice daily dosage. Therapeutic effects occur at blood levels > 5 mg/1, and side effects increase considerably at levels > 15 mg/1. Smoking, alcohol, anticonvulsants, and rifampicin induce the drug-metabolizing enzyme system in liver and reduce the half-life of theophylline. On the other hand, heart and liver failure, sustained fever, old age and drugs such as cimeti-dine, ciprofloxacin, and oral contraceptives reduce theophylline clearance and thereby increase serum concentrations. 

Crowley JJ, Cusack BJ, Jue SG, et al. Aging and drug interactions II. Effect of phenytoin and smoking on the oxidation of theophylline and cortisol in healthy men. J Phannacol Exp Ther... 

Schmucker DL. Aging and drug disposition an update. Pharmacol Re /1979 30 445-456. 

Cooper DS, Goldminz D, Levin AA, Ladenson PW, Daniels GH, Molitch ME, Ridgway EC. Agranulocytosis associated with antithyroid drugs. Effects of patient age and drug dose. Ann Intern Med 1983 98(l) 26-9. 

Age. The pharmacokinetic and pharmacodynamic effects of a drug can be influenced by age, and drug metabolism plays an important role in understanding the differences observed. Differences between the levels of metabolism enzymes for the fetal and neonatal (first 4 weeks postpartum) liver versus the adult liver have been observed in both animal and human studies (125). At birth, total CYP levels are approximately 30%of adult levels and glucuronidation activity is at 10-30% of adult levels. Interestingly, sulfotransferase activity in neonates seems to be comparable with that in adults. 

Benzi, G., Pastoris, O. and Villa, R.F. (1988) Changes induced by aging and drug treatment on cerebral enzymatic antioxidant system. Neurochem. Res. 13 467-478. 

Hader, D.-R, Lebert, M., and DiLena, M. IL (1987) Effects of culture age and drugs on phototaxis in the green flagellate, Eupflena gracilis. Plant Physiol. 6, 169-174. 

Nine out of 36 patients who developed acute renal failure while taking cefaloridine had also been taking a diuretic furosemide was used in 7 cases. Other factors such as patient age and drug dosage may also have been involved. The authors of this report related their observations to previous animal studies, which showed that potent diuretics such as furosemide and etacrynic acid enhanced the incidence and extent of tubular necrosis. Several other reports describe nephrotoxicity in patients given both cefalori-... 

Loi C-M, Parker BM, Cusack BJ, Vestal RE. Aging and drug interactions.III. Individual and combined effects of cimetidine and ciprofloxacin on theophyUine metabolism in healthy male and female nortsmoktrs. J Pharmacol Exp Ther 99T) 280,627-37. 

The effect of hemofiltration on drug elimination can be estimated from serum creatinine (SCr), age, and the MDRD-2 formula to predict the combined effect of filtration rate (eGFR = GFRresidual + HFR) on drug clearance and drug half-life during hemofiltration. 

Under federal law, limited quantities of certain schedule V drugs may be purchased without a prescription directly from a pharmacist if allowed under state law. The purchaser must be at least 18 years of age and must furnish identification. All such transactions must be recorded by the dispensing pharmacist. 

Roger Baccus, age 23 years, is prescribed Demerol for postoperative pain. You discover in his health history on the chart that he has a history of alcohol and drug use. Determine what further assessments you would need to make Explain how Roger s answers would influence the actions that you as a nurse would take. 

Outpatient group members were very similar to the inpatient PCP abusers in most sociodemographic and drug-use characteristics. Their mean age was 29 years, educational level 12.6 years, and number of prior arrests 1.5. The majority of outpatients were black (83 percent), unmarried (67 percent), and unemployed (67 percent). Their mean duration of PCP use was almost 8 years, with, usually, no prior or recent substance abuse treatment. Thirty-seven percent used PCP at least daily, always by smoking. Like the inpatient PCP abusers, outpatients frequently (87 percent) reported abuse of other drugs alcohol (46 percent), marijuana (46 percent), and cocaine (37 percent). Several outpatients for whom cocaine was the preferred drug of abuse used PCP as a "cheaper high" when cocaine was not affordable. 

Cyclosporine and tacrolimus are calcineurin inhibitors that are administered as part of immunosuppressive regimens in kidney, liver, heart, lung, and bone marrow transplant recipients. In addition, they are used in autoimmune disorders such as psoriasis and multiple sclerosis. The pathophysiologic mechanism for ARF is renal vascular vasoconstriction.41 It often occurs within the first 6 to 12 months of treatment, and can be reversible with dose reduction or drug discontinuation. Risk factors include high dose, elevated trough blood concentrations, increased age, and concomitant therapy with other nephrotoxic drugs.41 Cyclosporine and tacrolimus are extensively metabolized by... 

When sufficient evidence is available to determine that the patient has real seizures and is at risk for another seizure, pharmacotherapy is usually started (Fig. 27-2). The patient should be in agreement with the plan, be willing to take the medication, and be able to monitor seizure frequency and adverse drug effects in some way. Design of an appropriate pharmacotherapeutic plan is based on the patient s seizure type, the common adverse-effect profile of possible AEDs, and economic factors (e.g., cost of the drug, insurance formulary, and ability to pay). Other patient factors such as gender, concomitant drugs, age, and lifestyle also need to be considered. 

Metformin is the only Food and Drug Administration (FDA) approved oral diabetic agent in children (greater than or equal to age 10) other oral agents... 

---