Dose elderly

Doses listed are total daily doses elderly patients are usually treated with approximately one-half of the dose listed. 

Generally, nephrotoxicity is not a problem. Some cephalosporins, especially those with the 3-methylthiotetrazole side chain, such as moxalactam (48), show a tendency to promote bleeding. This appears to be due to a reduction in the synthesis of prothrombin and can be a problem especially in elderly patients, patients with renal insufficiency, or patients suffering from malnutrition (219). The same side chain seems to promote a disulfiramlike reaction in patients consuming alcohol following a cephalosporin dose (80,219). 

Oral calcium has long been used for the treatment of osteoporosis, both in the form of dietary and pharmacological supplements. In patients with calcium deficiency, oral calcium at doses of 1000-1500 mg/day corrects a negative calcium balance and suppresses PTH secretion. Sufficient calcium intake is most important for the acciual of peak bone mass in the young, but is also considered the basis of most anti-osteoporotic regimens. In the elderly, supplementation with oral calcium and vitamin D reduces the risk of hip fracture by about 30 4-0%. 

Before administering this drug to an elderly patient or one that has renal impairment, the primary health care provider may order a creatinine clearance. The initial dose is 50 to 100 mg PO or IV, depending on the results of the creatinine clearance. The nurse reports the laboratory results to the primary health care provider because dosage adjustments may be made on the results of the creatinine clearance. 

Age appears to increase the possibility of adverse reactions to the NSAIDs The risk of serious ulcer disease in adults older than 65 years is increased with higher doses of the NSAIDs Use greater care and begin with reduced dosages in the elderly, increasing the dosage slowly. 

Narcotic analgesics can produce serious or potentially fatal respiratory depression if given too frequently or in an excessive dose. Respiratory depression may occur in patients receiving a normal dose if the patient is vulnerable (ie, in weakened state or debilitated state). Elderly, cachectic, or debilitated patients may have a reduced initial dose until die response of the drug is known. If the respiratory rate is 10/min or below, the nurse must monitor die patient at frequent intervals and notify the primary health care provider immediately. 

When the nurse givesthese drugs to elderly patients confusion or excitement may be seen even with small doses... 

The nurse observesthe elderly patient receiving a cholinergic blocking drug at frequent intervals for excitement, agitation, mental confusion, drowsiness urinary retention, or other adverse effects. If any of these should occur, it is important to withhold the next dose of the drug and contact the primary health care provider. The nurse ensures patient safety until these adverse reactions disappear. 

Elderly patients may require a smaller hypnotic dose, and, in some instances , a sedative dose producessleep. 

B. elderly patients usually require larger doses of a hypnotic... 

In elderly or debilitated patients doses may be instituted at 1A> to Vs the recommended dose for younger adults and increased more gradually than dose increases in younger adults... 

Note Critically ill patients (e.g., elderly, organic mental syndrome, pulmonary, cardiac, renal, and/or hepatic impairment) may be at increased risk for adverse drug events. Start with the lowest dose and titrate very carefully. 

Generally, arblockers are considered as second-line agents to be added on to most other agents when hypertension is not adequately controlled. They may have a specific role in the antihypertensive regimen for elderly males with prostatism however, their use is often curtailed by complaints of syncope, dizziness, or palpitations following the first dose and orthostatic hypotension with chronic use. The roles of doxazosin, terazosin, and prazosin in the management of patients with hypertension are limited due to the paucity of outcome data and the absence of a unique role for special populations or compelling indications from JNC 7. 

The treatment of elderly patients with hypertension, as well as those with isolated systolic hypertension, should follow the same approach as with other populations with the exception that lower starting doses may be warranted to avoid symptoms and with special attention paid to postural hypotension. This should include a careful assessment of orthostatic symptoms, measurement of blood pressure in the upright position, and caution to avoid volume depletion and rapid titration of antihypertensive therapy.2 In individuals with isolated systolic hypertension, the optimal level of diastolic pressure is not known, and although treated patients who achieve diastolic pressures less than 60 to 70 mm Hg had poorer outcomes in a landmark trial, their cardiovascular event rate was still lower than those receiving placebo.69... 

A PPI may be warranted in patients older than 60 years of age.29 Proton pump inhibitors are the most useful option because they have superior efficacy and are dosed once daily. Elderly patients maybe sensitive to the central nervous system effects of metoclopramide and H2RAs. 

Patients at increased risk of NSAID-induced gastrointestinal adverse effects (e.g., dyspepsia, peptic ulcer formation, and bleeding) include the elderly, those with peptic ulcer disease, coagulopathy, and patients receiving high doses of concurrent corticosteroids. Nephrotoxicity is more common in the elderly, patients with creatinine clearance values less than 50 mL/minute, and those with volume depletion or on diuretic therapy. NSAIDs should be used with caution in patients with reduced cardiac output due to sodium retention and in patients receiving antihypertensives, warfarin, and lithium. 

Antipsychotics can be safe and effective for the treatment of psychosis in the elderly, if used at lower doses than those commonly used in younger adults. Older adults are particularly vulnerable to the side effects of FGAs. Parkinsonian symptoms... 

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