Elderly pancreatitis

Elderly In an expanded access program using a buffered formulation of didanosine for the treatment of advanced HIV infection, patients 65 years of age and older had a higher frequency of pancreatitis (10%) than younger patients (5%). 

Mesalamine (Asacol, Lialda, Pentasa, Rowasa) [Anti-inflcinimcifory/Seilicyleite] Uses Mild-mod distal ulcerative colitis, proctosigmoiditis, proctitis Action Unknown may inhibit prostaglandins Dose Rectal 60 mL qhs, retain 8 h (enema), 500 mg bid-tid or 1000 mg qhs (supp) PO Cap 1 g PO qid Tab 1.6-2.4 g/d doses (tid-qid) delayed release 2.4-. 8 g PO daily 8 wk max, do not cut/crush/chew w/ food initial dose in elderly Caution [B, M] Contra Salicylate sensitivity Disp Tabs, caps, supp, rectal susp SE HA, malaise, abd pain, flatulence, rash, pancreatitis, pericarditis Interactions X Effect OF digoxin EMS May turn urine yellow-brown OD May cause NA /D, tinnitus, HA, and drowsiness activated charcoal may be effective... 

Stavudine should be used with caution in patients at risk for hepatic disease and those who have had pancreatitis. Persons with peripheral neuropathy, the elderly, and those with advanced HIV disease are at increased risk for neurotoxicity. Dosage adjustment is required for patients with renal insufficiency. 

Co-trimoxazole can cause reversible hypoglycemia, which may be prolonged, particularly in patients with risk factors for hypoglycemia. Common risk factors include compromised renal function, prolonged fasting, malnutrition, and the use of excessive doses. It has been postulated that the sulfonamide mimics the action of sul-fonylureas, stimulating pancreatic islet cells to secrete insulin. In elderly people, co-trimoxazole-induced hypoglycemia can cause altered mental state (1146,1147). 

In addition, numerous life-threatening adverse reactions have come to the forefront with the newer atypicals, such as hypertension cardiovascular disease, including stroke in the elderly obesity elevated serum cholesterol elevated blood sugar diabetes and pancreatitis. Finally, there is compelling new evidence linking neuroleptic use to premature death. 

Ranitidine is generally well tolerated but may occasionally cause diarrhoea and other gastrointestinal disturbances, altered liver function tests, headache, dizziness, rash and tiredness. Other rare side-effects include acute pancreatitis, bradycardia, atrioventricular block, confusion, depression and hallucinations, particularly in the very ill or elderly. 

Beta adrenergic receptor antagonists reduce cardiac output (caused by negative chronotropic and inotropic effects), decrease renin release from the kidneys, and cause smooth muscle relaxation. However, blockage may also decrease secretion of insulin from pancreatic P-cells, which limits its use in T2D. Calcium channel antagonists act on L-type voltage gated channels in the heart and blood vessels to reduce vascular resistance and arterial pressure. Diuretics are also widely used to decrease blood pressure, particularly in the elderly and hypertensive black populations. 

Phenol is cardiotoxic, and varions cardiac dysrhythmias have been noted after apphcation to the skin, or less commonly when it has been nsed for nenrolysis. Ventricular extra beats occurred during topical apphcation of phenol and croton oil in hexachlorophene soap and water for chemical peehng of a giant hairy nevus (12). Three of sixteen children treated with motor point blocks for cerebral palsy with a phenohc solution under halothane anesthesia developed cardiac dysrhythmias (13). Severe cardiac dysrhythmias followed by circulatory arrest occurred in an elderly patient with pancreatic cancer, injected with a phenohc solution to produce splanchnic neurolysis (14). The authors recommended that ethanol should replace phenol for this purpose. 

Pernicious anemia, a deficiency of intrinsic factor, is a relatively common problem caused by malabsorption of dietary cobalamin. It may result from an inherited defect that leads to a decreased ability of gastric parietal cells to synthesize intrinsic factor or from partial resection of the stomach or of the ileum. Production of intrinsic factor often declines with age and may be low in elderly individuals. An alternative circumstance that leads to the development of a B12 deficiency is pancreatic insufficiency or a high intestinal pH, which would result from too little acid being produced by the stomach. Both of these conditions prevent the degradation of the R-binder-B12 complex as a result, B12 will not be released from the R-binder protein and, therefore, cannot bind to intrinsic factor. 

Apart from mediating the action of catecholamines, cAMP and its congener cGMP are common secondary-transmitters of hormone action. For example, they play the main part in liberating insulin from the pancreas in vivo. Tolbutamide 12.61) and similar sulfonylureas (such as chlorpropamide, tolazamide, and glibenclamide), which are used to alleviate the diabetes of elderly people, somewhat selectively inhibit pancreatic phosphodiesterase and thus preserve cAMP from destruction (Goldfine, Perlman and Roth, 1971). Activity within a series of sulfonylureas is positively correlated with lipophilicity and also with binding by serum albumin (Seydel, Ahrens and Losert, 1975). These cyclic phosphates also mediate the diuretic effect of vasopressin, and the action of ACTH and many other hormones (Sutherland, (Z)ye and Butcher, 1965). 

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