DRUG USED IN GERIATRICS

Vrushali Neve
Asst. Professor
Pharmacology Dept.
KGRDCP & RI, Karjat
 Introduction
1.Geriatrics refers to physical, pathological aspects of elderly
2.The elderly have multiple and often chronic diseases.
3.It is not surprising therefore that they are major consumer of
drugs.
4.Common diseases in geriatrics are:
A. Hypertension
B. Diabetes mellitus
C. Arthritis
D. Hearing loss
E. Parkinson's disease
F. Alzheimer disease
 Who is old?
60+, 70+, 80+, 90+…?

We are born as copies and die as

originals
Bo G Eriksson
 Elderly more sensitive to drugs
because
• Reduced amount of water in the body -fat soluble drugs
remain longer in the body with prolonged effects – of
importance for some sedatives and anxiolytics
• Reduced kidney function - decreased excretion of some
cardiovascular drugs, some antibiotics, diabetic drugs,
antiinflammatory drugs – need to reduce dosage
• Reduced liver function – decreases metabolism of opioids,
bensodiazepines and some antidepressive drugs
• Brain and nervous system more sensitive to psychotropic and
analgesic drugs – dizziness, confusion
 Drug safety in the elderly
Do we have a problem? Yes!
Top ten medicines reported by the EU member states
to WHO in 2010 - women and men 80+

1. Acetylsalicycic acid 6. Enalapril

2. Warfarin 7. Rovecoxib
3. Lefloxacin 8.Digoxin
4. Furosemide 9. Clopidogrel
5. Acenocoumarol 10. Ciprofloxacin
 Why do we have a problem with
safety of drug treatment in the elderly?
• Many drugs prescribed to older patients not tested in this age
group
• Prescribers lack education about how to treat older patients
with drugs
• Older people are treated for their symptoms, not based on
diagnosis
• Effects of drug treatment in the individual patient is not
monitored
• Lack of coordination between different doctors` treatment of
an individual treatment
• Patients lacking knowledge about drugs and how to use them
 PRINCIPLE UNDERLYING FACTORS

• Altered Pharmacokinetics
• Altered Pharmacodynamics
• Multiple drug therapy
• Poor compliance
 Pharmacokinetic changes in geriatrics
Ageing result in many physiological changes that could affect
absorption, first pass metabolism ,distribution ,protein binding and
elimination of drugs
Age related changes in GI tract ,liver and kidney are:
1.Reduce gastric acid secretion
2.Decresed GI motility
3.Reduced total surface of absorption
4.Reduced splanchnic blood flow
5.Reduced liver size
6.Reduced liver blood flow
7.Reduced glomerular filtration
8.Reduced renal tubular filtration
1. Absorption: There is delay in gastric emptying, reduction in
gastric acid output with aging. Absorption of some drug like
digoxin may be slower .
2. First pass metabolism: a .After absorption drug are
transported via portal circulation to liver where many lipid
soluble drugs are metabolized extensively.
b. This result in marked reduction in systemic bioavailability.
c. Minor reduction in first pass metabolism can result in
significance increase in bioavailability of such drugs.
3. Distribution: Age related physiological change which may affect
drug distribution are :
1. reduced lean body mass
2.Reduced total body water
3. Increased total body fat
4. Lower serum albumin level
❖ Increased body fat in elderly result in increased volume of
distribution for fat soluble compound such as clomethiazole
,diazepam.

❖ Reduction in body water result in reduced volume of

distribution of water soluble drugs like cimetidine, digoxin,
alcohol

❖ Plasma albumin level decreases with age therefore free

fraction of acidic drugs like cimetidine, furosemide will
increases
4. Renal clearance: There will be variability in renal function in
elderly , in general glomerular filtration rate decline which affect
renal plasma flow and renal tubular function. Because of marked
variability in renal function in elderly dosage of predominantly
renal excreted drug should be individualized.

5.Hepatic clearance, ClH: It is depend on hepatic blood flow Q,

and steady state extraction ratio E, as seen in formula :
Cl H = Q × Ca- Cv/Ca
where Ca and Cv are arterial and venous
concentrations of drug
 Pharmacodynamics

1.Age related changes in specific receptors and target sites:

1.α adrenoreceptors: It appears to reduced with ageing while α1
adrenoreceptor responsivness is unaffected

2.β adrenoreceptors: Its function is decline with age. It is recognise

that chronotropic response to isoprenaline infusion is less marked
in elderly
2.Reduction in homeostasis:
1. Orthostatic circulatory response: Structural changes in vascular
tree that occur with ageing . Antihypertensive drug with α receptor
blocking effect, antiparkinson drugs more likely to produce
hypotension in elderly

2.Thermoregulation: Increases of thermoregulatory mechanism in

elderly .Ex. Benzodiazepines, opioids, alcohol.

3. Congitive function :Aging is associated with marked structural

and neurochemical changes in CNS
 Drugs that need to be used with caution in
elderly
DRUGS SIGNIFICANT ADR SPECIAL
CONSIDERATION

NSAID GI, Ulceration, bleeding First try Paracetamol,

renal impairment monitor renal function

Antibiotic- Cotrimazole Serious hypersensitivity Trimethoprime is equally

reaction safe, effective for UTI

Sulfonylureas (long Increase risk of Shorter acting agents are

acting) hypoglycemia preferred

Colchicine Diarrhoea ,dehydration Not recommended for

chronic therapy
 Principle and goals of drug therapy
1. Unnecessary use of hypnotics should be avoided in mild
hypertension
2. Aim of treatment is not just to prolong life but also to improve
quality of life
3. Drug history will help to avoid potentially serious drug
interaction
4. Dose titration will help to know age related alteration that may
effect drug response
5. Packaging and labeling: Many elderly patients with arthritis
find it difficult to open container
 Care to be taken
❖ Select drugs reported to be safe
❖ Avoid unsafe drugs
❖ Prepare dose and dosing schedule
❖ Record drug history carefully before prescription
❖ Try to reduce use of number of drugs