Drug risks and iatrogenesis in the elderly

2011 International Seminar on Geriatrics (Athens, April 1-3 2011) Denutrition and drugs in the elderly Pr. Patrice QUENEAU De l’Académie Nationale de Médecine

[object Object],[object Object],[object Object],2011

INTRODUCTION ,[object Object],[object Object],[object Object],[object Object],[object Object],2011

INTRODUCTION 2011 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

IATROGENESIS IN THE ELDERLY ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],2011

[object Object],2011 Polymedication Automedication Poor compliance Aging Adverse effect of the drug Inadequate drug concentration Altered organ response Reduction of functional capacity Homeostatic dysregulation

CONCEPT OF "INAPPROPRIATE DRUG PRESCRIPTION" ,[object Object],[object Object],[object Object],2011

AGING AND CHANGES IN BODY SIZE ,[object Object],[object Object],2011

CHANGES IN COMPARTMENTAL DISTRIBUTION IN THE ELDERLY ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],2011

CHANGES IN BODY WATER COMPARTMENTS WITH AGING FAT MASS 26 kg LEAN MASS 44 kg LEAN MASS 55 kg FAT MASS 15 kg 42 L of water 35 L of water 20 yrs - 70 kg Water : 60% of total weight / 85 yrs - 70 kg Water : 50% of total weight 2011

CHANGES IN DRUG DISTRIBUTION LINKED TO BODY SIZE ,[object Object],[object Object],[object Object],[object Object],2011

[object Object],[object Object],[object Object],CHANGES IN DRUG DISTRIBUTION LINKED TO BODY SIZE 2011

AGE-RELATED CHANGES IN THE DISTRIBUTION VOLUME (Vd) OF CERTAIN DRUGS 2011 Vd  Vd  Vd  Furosemide Amikacin Gentamycin Isoniazid Paracetamol Warfarin Alprazolam Diazepam Lidocaine Acetyl-salicylic acid Anthracyclines Morphine Digoxin Cisplatin

DENUTRITION AND CREATININE PRODUCTION 2011 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

PRACTICAL ASSESSMENT OF GLOMERULAR FILTRATION RATE Rev Med Int 2008 ; 29 : 364 - 69 Comparative study of Carbonnel et al. 81 patients Mean age 82.3  7.0 Mean albumin 33.3  5.2 Mean weight 59.6  14.8 120 40 80 0 Cockcroft & Gault 42.1  17.1 Creat / Urine cl. 33.7  21.3 MDRD 49.9  16.4 2011

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SOME EXAMPLES OF AT-RISK SITUATIONS ,[object Object],[object Object],[object Object],[object Object],[object Object],2011

ANTIVITAMINS K AVK ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],2011

ANTIVITAMINS K AVK ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],2011

ANTIVITAMINS K AVK ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],2011

Strong corrélation ( 80 %) between % of Adverse Drug Events and number of drugs (study in Emergency Units) P. Queneau, Drugs Safety, 2006 P. Queneau

PSYCHOTROPIC DRUGS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],2011

[object Object],MALETTA G. Geriatrics 1991 ; 46 : 40 - 60 SHORR R. Drugs and Aging 1994 ; 4 : 9 - 20 G + Glucuronidation (phase II) O = Oxydation (phase I) 2011 OXAZEPAM Seresta ALPRAZOLAM Xanax DIAZEPAM Valium Half-life Adult Short (< 10 H) 7 H Intermediate 10 -> 20 H 11 H Long (> 20 H) 46 H Minimum duration of "steady state" 2 d 2 d 10 d Active metabolite No  O (G) (Alpha OH Alprazolam) + + (O) Desmethyldiazepam 29 to 223 H Temazepam 8 to 38 H Half-life Elderly 8 H 19 H 90 H

PSYCHOTROPIC DRUGS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],2011

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],ANTIDIABETIC DRUGS 2011

ANTINEOPLASTIC DRUGS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],2011

CONCLUSION MAJOR DRUGS INVOLVED IN CASE OF DENUTRITION ,[object Object],[object Object],[object Object],2011

Evidence based medicine: what it is and what it isn ’ t L ’Evidence-Based Medicine by the Working Goup JAMA 1992, 268 (17): 2420-5 avid L Sackett, William M C Rosenberg, J A Muir Gray, R Brian Haynes, W Scott Richardson+Author Affiliations ,[object Object]

Limites (et critiques) de l’EBM ? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],6-7-8 septembre 2007 P. Queneau, J. Doucet, F. Paille L ’Evidence-Based Medicine Working Goup JAMA 1992, 268 (17): 2420-5

UNFRACTIONATED HEPARIN UFH ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],2011

LOW MOLECULAR WEIGHT HEPARIN LMWH ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],2011

Drug risks and iatrogenesis in the elderly

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Drug risks and iatrogenesis in the elderly

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