Intolerance elderly

The increased incidence of glucose intolerance, congestive heart failure, and hypertension among elderly... 

There are also those who believe that they have an intolerance to gluten, i.e. a problem with digesting gluten, but without the full immune response to gluten found in coeliac disease. Coeliac disease is found in all age groups but its occurrence is greatest in the elderly. 

Diphenhydramine Diphenhydramine also is indicated for active treatment of motion sickness (injection only) for parkinsonism in the elderly intolerant of more potent agents, for mild cases in other age groups, and in combination with centrally... 

Side effects, mainly due to serotonin reuptake inhibition include G1 upset, nervousness, and sexual dysfunction. SSRls are associated with an increased risk of falls. Hyponatraemia due to SIADH is an uncommon, but important side effect in elderly patients. Selective serotonin and norepinephrine reuptake inhibitors (S SNRls) such as venlafaxine and duloxetine are also useful in older patients. Other heterocyclic antidepressants of importance in older patients because of relative safety include bupro-prion and mirtazepine. They are reserved for patients with resistance to or intolerance of SSRls. Currently, trazodone is used mostly for sleep disturbance in depression in doses of 50-100 mg at bedtime. The monoamine oxidase inhibitors phenelzine. 

The effectiveness of orphenadrine is less than that of biperiden and trihexyphenidyl. However it can be of use in patients with a mild form of the disease. It can also be of advantage in some elderly patients with intolerance for more potent anticholinergics. 

Adverse effects consist mainly of gastrointestinal intolerance such as nausea, epigastric pain and diarrhea and, especially in the elderly constipation with continued therapy. All ferrous salts may cause a black coloration of the faeces. Children are particularly susceptible to potentially lethal iron intoxications. Oral iron preparations should not be administered concurrently with tetracyclines as mutual interference with absorption will occur. 

Although all patients with depression should undergo a thorough medical evaluation, no specific tests are required before SSRI therapy is initiated. The usual starting doses of SSRIs are summarized in Table 2-1. These standard doses should be decreased by 50% in patients with hepatic disease and in elderly persons. In addition, patients with panic disorder or significant anxiety symptoms are often intolerant of the initial stimulating side effects that commonly occur with SSRI use. In these cases, the initial dose should be decreased... 

For those with a history of substance abuse or intolerance to benzodiazepines and the elderly, caution must be used in controlling anxiety. In these cases, benzodiazepines may exacerbate other conditions. Preliminary reports suggest that antipsychotics such as quetiapine may alleviate symptoms of anxiety. Other strategies include use of antihistamines such as hydroxyzine and diphenhydramine. 

ECT should be considered for more severe forms of depression (e.g., those associated with melancholic and psychotic features, particularly when the patient exhibits an increased risk for self-injurious behavior) or when there is a past, well-documented history of nonresponse or intolerance to pharmacological intervention. Limited data indicate that bipolar depressed patients may be at risk for a switch to mania when given a standard TCA. A mood stabilizer alone (i.e., lithium, valproate, carbamazepine, lamotrigine), or in combination with an antidepressant, may be the strategy of choice in these patients. Some elderly patients and those with acquired immunodeficiency syndrome may also benefit from low doses of a psychostimulant only (e.g., methylphenidate) (see also Chapter 14, The HIV-Infected Patient ). Fig. 7-1 summarizes the strategy for a patient whose depressive episode is insufficiently responsive to standard therapies. 

The toxicity of thyroxine is directly related to the hormone level. In children, restlessness, insomnia, and accelerated bone maturation and growth may be signs of thyroxine toxicity. In adults, increased nervousness, heat intolerance, episodes of palpitation and tachycardia, or unexplained weight loss may be the presenting symptoms. If these symptoms are present, it is important to monitor serum TSH (Table 38-2), which will determine whether the symptoms are due to excess thyroxine blood levels. Chronic overtreatment with T4, particularly in elderly patients, can increase the risk of atrial fibrillation and accelerated osteoporosis. 

Symptoms of hypothyroidism include lack of energy, fatigue, sleepiness, poor memory, lack of concentration, bradycardia and cold intolerance. Women are more often affected than men and the condition is more common in the elderly. 

Elderly patients seem to be particularly sensitive to and intolerant of flurbiprofen one study reported adverse effects in 80% (SED-11, 183) (5). 

The major limitation to the use of spironolactone is its liability to cause (sometimes lethal) hyperkalemia, particularly in the elderly, in patients with reduced renal function, and in patients who simultaneously take potassium supplements or ACE inhibitors. As with other diuretics, hyponatremia and dehydration can occur. Other less frequent adverse effects are gastrointestinal intolerance, neurological symptoms, and skin rashes. Hypersensitivity rashes and a lupus-Uke syndrome have been reported rarely. A few cases of mammary carcinoma have been reported and potential human metabolic products of spironolactone are carcinogenic in rodents. Second-generation effects have not been reported. 

Frequent Dry mouth (sometimes severe), constipation, decreased sweating Occasional Blurred vision, intolerance to light, urinary hesitancy, drowsiness (with high dosage), agitation/excitement/drowsiness noted in elderly (even with low doses). IM may produce transient lightheadedness, irritation at injection site. 

Glucose Intolerance in the Elderly. Glucose intolerance is age related and chromium supplementation trials in the elderly have been conducted with variable results. The inabihty to determine which of the elderly trial subjects was initially chromium depleted makes it difficult to interpret the findings. If the observations can be confirmed and there is an age-related decrease in the chromium concentration in hair, sweat, and blood serum, then there is a necessity for further studies in the elderly. ... 

I Adverse Effects. Side effects (see Table 54—6) of carbamazepine may fluctuate daily, paralleling the rise and decline of serum concentrations. The side-effect profile also may follow a circadian rhythm. Neurosensory side effects (e.g., diplopia, blurred vision, nystagmus, ataxia, unsteadiness, dizziness, and headache) are the most common, occurring in 35% to 50% of patients. These side effects are more common during initiation of therapy and may dissipate with continued treatment. Patients have variable threshold concentrations for the occurrence of CNS side effects. If the carbamazepine serum concentration is kept below the individual threshold, the CNS side effects can be minimized. Dosage manipulation, including the use of the controlled- or sustained-release preparations, should be tried before the patient is considered to be intolerant of carbamazepine. Carbamazepine may induce a hyponatremic hyposmolar condition that is similar to the syndrome of inappropriate antidiuretic hormone secretion. The incidence may increase with age. Periodic determinations of serum sodium concentration are recommended, especially in the elderly." ... 

On average, only 30% to 60% of patients are able to tolerate oral CAI therapy for prolonged periods. Intolerance to CAI therapy results most commonly from a symptom complex attributable to systemic acidosis and including malaise, fatigue, anorexia, nausea, weight loss, altered taste, depression, and decreased libido. Other adverse effects include renal calculi, increased uric acid, blood dyscrasias, diuresis, and myopia. Elderly patients do not tolerate CAIs as well as younger patients. The three available CAIs produce the same spectrum of adverse effects however, the drugs differ in the frequency and severity of the adverse effects listed. Acetazolamide (standard or sustained-release capsules) and methazolamide are considered the best-tolerated CAIs. 

Elderly patients often face a number of barriers to compliance related to their age. Such barriers include increased forgetfulness and confusion altered drug disposition and higher sensitivity to some drug effects decreased social and financial support decreased dexterity mobility, or sensory abilities and an increased number of concurrent medicines used (both prescription and over-the-counter), whose attendant toxicities and interactions may cause decreased mental alertness or intolerable side effects. 

Graves disease, uncommon in the elderly, usually presents with a diffusely enlarged goiter with a bruit. The common symptoms of heat intolerance, tremor, tachycardia, and so on, may be erroneously attributed to normal aging or commonly present coexisting diseases in the elderly. 

Faraday was bom in south London to a poor family his father was a Yorkshire blacksmith who suffered ill-health throughout his life. In the rigidly class-conscious England of that day, a poor lad like Faraday had no chance of much of a formal education and indeed in his early years he suffered considerably from intolerance of this kind, particularly from the wife of the scientist Humphrey Davy who employed Faraday as laboratory assistant. He appears to have borne no rancor as a result he was a devout member and elder of the small Sandemanian denomination, an offshoot of the Church of Scotland. During his lifetime, Faraday rejected a knighthood and twice refused to become President of the Royal Society. There is a plaque in his memory in Westminster Abbey near Newton s tomb, but he refused to be buried there and is interred in the Sandemanian plot in Highgate Cemetery in London. 

The NSAID-sparing effect of capsaicin can reduce the unwanted side effects of NSAIDs such as platelet-related aggregation abnormalities, peptic ulcer problems, or cardiovascular and renal complications. It may be particularly useful in the elderly, who are often intolerant to opioids and NSAIDs. 

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