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Polypharmacy

Background, Goal and Objectives Polypharmacy PDF
Polypharmacy - weighing up the benefits and harms
Elderly people are at increased risk of drug related problems
Drugs associated with increased risk of adverse drug reactions in elderly people
Common drug interactions in elderly people
Recognising adverse drug reactions
Risk factors for drug related problems in elderly people
A really good recipe for DRP
Drug related harm; terms and definitions
Hospital admissions for adverse drug reactions
Commonly reported adverse drug reactions
References, Bibliography

Elderly people are at increased risk of drug related problems

Elderly people are at particular risk of drug related problems because of complex drug regimens involving multiple drugs and the physiological changes which accompany aging. Up to 30 percent of hospital admissions in the elderly may be associated with drug related problems (Hanlon, 1997).

Large clinical trials often exclude elderly people and those with co-morbidities. This means that subjects of trials are often very different from the elderly patients with multiple co-morbidities seen in practice. A UK study found stroke patients in primary care were on average 12 years older than patients in the research which formed the basis of national guidelines for blood pressure lowering for patients with stroke (Mant, 2006). The guidelines, therefore, cannot be applied uncritically to the patients of these practices.

Prescribers need to consider the special needs of elderly patients when following clinical guidelines. If they do not, they are likely to expose their patients to increased risk of drug related problems.

Changes which accompany aging make people particularly susceptible to drug related problems.

Physiological changes associated with aging affect a person’s handling and response to drugs. Changes in the excretion and metabolism of drugs lead to increased drug concentrations, changes in receptor sensitivity cause exaggeration or blunting of drug effects, and decline in cognitive function makes adherence to a complex drug regimen difficult.

Age related changes which increase the risk of drug related problems
Circulatory instability Liver metabolism slows
       
Renal function declines   Increasing age   Receptor sensitivities change
   
       
Gastro-protection reduced Cognitive function declines

Some examples of age related changes to drug effects include:

  • increased postural sway with benzodiazepines
  • increased sensitivity to CNS drugs, e.g. benzodiazepines, opioids, antipsychotics and antiparkinson drugs
  • postural instability pre-disposing to drug induced hypotension and drug related falls
  • increased analgesic effect of morphine
  • reduced peak diuretic response to frusemide
  • increased anticoagulant effect of warfarin, and
  • impaired thermoregulatory mechanisms predisposing to drug induced hypothermia

Mangoni and Jackson, 2003


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