Geriatric patient

Aniracetam (6), launched in 1993 in both Japan and Italy for the treatment of cognition disorders, is in Phase II trials in the United States as of this writing. In clinical studies it has been shown to cause some improvement in elderly patients with mild to moderate mental deterioration (63), and in geriatric patients with cerebral insufficiency (64). In a multicenter double-blind placebo-controUed trial involving 109 patients with probable AD, positive effects were observed in 36% of patients after six months of treatment (65), a result repeated in a separate study of 115 patients (66). A review of the biological and pharmacokinetic properties, and clinical results of aniracetam treatment in cognitively impaired individuals is available (49). 

The fluoroquinolones are used cautiously in patients with renal impairment or a history of seizures, in geriatric patients, and in patients on dialysis. 

Tolonen, M., Halme, M. and Sama, S. (1985). Vitamin E and selenium supplementation in geriatric patients. A doubleblind preliminary clinical trial. Biol. Trace Element Res. 7, 161-168. 

Recommend treatment approaches for special populations of patients with bipolar disorder, including pediatric patients, geriatric patients, and pregnant patients. 

Sepsis syndrome Anorexia nervosa Complications during pregnancy Geriatric patients with multiple chronic disease Organ transplantation Inborn errors of metabolism Cystic fibrosis Extreme prematurity... 

The prevalence of obesity in older adults is increasing therefore, it should not be surprising that more cardiovascular risk factors are present in this group of individuals. Additionally, obesity is a major predictor of functional limitation and mobility problems in older persons. Age alone should not prejudice the clinician from treating geriatric patients, whereas the benefits of cardiovascular health and functionality should be considered. Treatments should be initiated that minimize adverse effects on bone health and nutritional status and should include dietary and activity modifications.6... 

Tiltabs. Tiltab tablets represent one of the few dosage formulations that has been developed expressly to meet the needs of patients with impaired dexterity [185], Marketed by Smith, Kline French Laboratories, Ltd. in several European countries, the novelty of the Tiltab design is its irregular shape that prevents it from lying flat. Apparently, tablets manufactured in this fashion are easier to handle by those with impaired dexterity. Moreover, these tablets are readily identifiable by patients so that differentiation from other medication is facilitated. Other innovations like this are needed for drug-delivery systems with the particular needs of the geriatric patient in mind. 

C. C. Fuselier, General principles of drug prescribing, in Pharmacy Practice for the Geriatric Patient (F. B. Penta, et al., eds.), American Association of Colleges of Pharmacy, Alexandria, VA, 1985, pp. 8.1-8.28. 

L-acetylcarnitine is produced naturally in the CNS and indirectly stimulates acetylcholine production, as well as purportedly modulating cerebral metabolism. A study of nearly 500 geriatric patients in Italy provided evidence that L-acetylcarnitine... 

For some bedridden or geriatric patients, or others with chronic constipation, bulk-forming laxatives remain the first line of treatment, but the use of more potent laxatives may be required relatively frequently. Agents that may be used in these situations include milk of magnesia and lactulose. 

Horne R and Weinman J (1999) Patients beliefs about prescribed medicines and their role in adherence to treatment in chronic physical illness. J Psychosom Res 47(6) 555-567 Kannisto V, Lauritsen J, Thatcher AR et al. (1994) Reductions in mortality at advanced age several decades of evidence from 27 countries. Population and development review 20(4) 793-810 Lazarou J, Pomeranz BH, Corey PN (1998) Incidence of adverse drug reactions in hospitalized patients a meta- analysis of prospective studies. JAMA 279(15) 1200-1205 LeSage J (1991) Polypharmacy in geriatric patients. Nurs Clin North Am 26(2) 273-290 Pitkala KH, Strandberg TE, Tilvis RS (2001) Is it possible to reduce polypharmacy in the elderly ... 

The efficacy document E7 (ICH 1993) states that the drug should be studied in all patient groups, elderly included, for which they have a significant utility. It also includes new uses, new formulations and new combinations of established medicinal products when there is specific reason to expect that conditions common in the elderly (e.g. renal or hepatic impairment, impaired cardiac function, concomitant illness or medication) are likely to be encountered. This also applies for when the geriatric patients response (safety, tolerability, efficacy) is different from the nongeriatrics. ... 

Before the arrival of the new antidepressants, the older tricyclic antidepressants were widely used to treat depression and agitation in demented patients. They have now largely been abandoned in these patients as their prominent anticholinergic effects tend to worsen dementia and the increased risk for cardiac toxicity can be especially dangerous in geriatric patients. 

Elderly Geriatric patients often require reduced dosage because of impaired renal function. In patients with severe impairment, dosage should not exceed 20 g in 48 hours. Monitor serum magnesium in such patients. 

Hypoglycemia Geriatric patients, malnourished patients, and those with adrenal or pituitary insufficiency are more susceptible to the glucose-lowering effect of these... 

Initial dose 5 mg, given approximately 30 minutes before breakfast to achieve the greatest reduction in postprandial hyperglycemia. Geriatric patients or those with liver disease may be started on 2.5 mg of the immediate-release formulation. 

Initial dose 5 mg/day, given with breakfast. The recommended dose for geriatric patients is also 5 mg/day. HbA- c level measured at 3-month... 

Geriatric patients or patients with debilitating disease 5 mg 2 to 4 times/day. 

Elderly- Geriatric patients are particularly sensitive to the side effects of... 

HALOPERIDOL Individualize dosage. Children, debilitated, or geriatric patients and those with a history of adverse reactions to neuroleptic drugs may require less haloperidol. 

Adults - 15 mg 30 minutes before meals and 30 mg at bedtime. For patients with mild manifestations, geriatric patients, or those of small stature, take 7.5 mg 3 times daily. 

Eideriy Dosage reduction may be required in geriatric patients, depending on the underlying renal status of the patient. 

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