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Guides to drug

Prescription for the elderly


& Pregnant women
By: Amr Mohammed Abdullah
11110053
Internal Medicine: Clinical pharmacology/Geriatric
medicine

Prescribing drugs in the


elderly:
guide to general
principles

Introduction
Population aging is considered as the most serious problem in
developed countries and is going to be a threat for
developing countries.
Aging is associated with various physiological changes and
multiple diseases alter the pharmacological response to a
drug.
Moreover, elderly people are more sensitive to frequently
used drugs like NSAIDs, benzodiazepines, opioids etc.
All these factors alter the drug response resulting in adverse
drug reactions (ADRs) and hospitalization, consuming 40% of
health service expenditure in developed countries.

Factors causing ADR in elderly

Age related pharmacokinetics


changes in the elderly

Commonly used drugs & their


adverse effects in elderly

Principles of prescribing in
elderly

Good PalliativeGeriatric Practice


Algorithm:
Improving drug
therapy in elderly
patients

Conclusion
Drug therapy in older patients varies from that of adults due to:

altered physiological functions.


associated illness.
age related disability.
Loneliness.
stress.

The success of a drug therapy in elderly, depends on considering these


factors in addition to correct:

Diagnosis.
treatment plan.
Prescription.
patient education.
dose adherence.

Care should be taken to avoid iatrogenic diseases in this population by


avoiding inappropriate prescribing.

Conclusion
For appropriate and rational prescription in elderly patients
the following factors should be taken into account.

age related pharmacokinetic and pharmacodynamic changes.


socioeconomic, cultural and psychological factors.
multiple diseases and altered presentation of illness.
decreased vision, cognitive and hearing impairment.
polypharmacy and increased susceptibility to ADRs.

Above all adding quality life to years should be the major


concern of a physician than mere addition of years to
life.

Prescribing in pregnant
women:
guide to general
principles

Introduction
Over 80 percent of women in the UK report taking
medications during their pregnancy.
Most will be unaware of the background risk of
congenital malformations and that their own risk of
having a baby with a congenital malformation may be
increased by exposure during pregnancy to some
medicines and chemicals.
Alcohol, nicotine, drugs of abuse and certain disease
states also increase the risk of congenital
malformations, as do some genetic factors.

Teratogenic effects

Drugs which are fetotoxic when taken


in the 1st trimester

Drugs which are


fetotoxic when
taken in the 2nd &
3rd trimester

FDA pregnancy risk factors


categories

Key points
assess or reassess the need for medication in any
woman planning a pregnancy, or who becomes pregnant.
consider whether it is appropriate to try nondrug
measures.
review medical history & consider obstetric history and
family history of malformations.
balance risks of medication against benefit of treatment
on mother and fetus.
consider safety of medication (stage of pregnancy, route
of administration, dose)

Key points
use the lowest effective dose for the shortest
possible time.
monitor efficacy of medication throughout
exposure.
always assess risks and benefits on an individual
patient basis.
ensure the most up-to-date information is being
used.
patient counselling regarding drug exposure during
pregnancy.

The Home message

All drugs should be prescribed


at the lowest effective dose for
the shortest possible time in
pregnancy,
and the risks and benefits
assessed on an individual basis

References
Drug Therapy for the Elderly [Wehling 2013]
clinicians-handbook-of-prescription-drugs
www.elsevier.es
http://www.elsevier.es/en-revista-medicina-universitaria-304articulo-use-of-medications-on-the-90367606

www.japi.org
http://japi.org/july_2008/u_525.html

www.onlinelibrary.wiley.com
http://onlinelibrary.wiley.com/doi/10.1002/psb.578/pdf

Thank U