Geriatric pharmacology is a specialized field focusing on medication use in elderly individuals
It explore challenges like polypharmacy, age-related changes in drug metabolism, and the importance of personalized treatment plans for older patients.
20% of hospitalization for those > 65 are due to the medication they’re taking
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GERIATRIC PHARMACOLOGY Geriatric pharmacology is a specialized field focusing on medication use in elderly individuals
1. G E R I A T R I C
PHARMACOLOGY
BY
ABHINAV S ( 2n d Year MBBS)
GMC Thir uvallur,TamilN adu
2. CONTENTS
Introduction to Geriatric Pharmacology
Renal Function Changes
Hepatic Changes
Drug Dosage Adjustments
Drug Absorption and Distribution
2
3. CONTENTS
Cardiovascular System in the Elderly
Specific Considerations for Males
Adverse Drug Reactions in the Elderly
Multiple Drug Therapy Challenges
Polypharmacy
Conclusion
3
4. Introduction
Geriatric pharmacology is a specialized field focusing on
medication use in elderly individuals
It explore challenges like polypharmacy, age-related changes
in drug metabolism, and the importance of personalized
treatment plans for older patients.
20% of hospitalization for those > 65 are due to the
medication they’re taking 4
5. Physiologic Changes of Aging Affecting
Absorption
Physiologic change
• Decreased gastric acidity
• Decreased gastrointestinal blood flow
• Delayed gastric emptying
• Slowed intestinal transit time
General clinical effect
• None on passive diffusion or bioavailability for most drugs
• Decreased active transport: Decreased bioavailability for
some drugs
• Decreased first-pass effect: Increased
bioavailability for some drugs
5
6. Physiologic Changes of Aging Affecting
Distribution
Decreased Total body water
Decreased Lean body mass
Decreased Serum Albumin
Decreased Alpha 1 Acid glycoprotein
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7. Physiologic Changes of Aging Affecting
Elimination
Physiologic change
Decreased GFR
Decreased renal blood flow
Decreased renal mass
General clinical effects
Increased (t½) of renally eliminated
drugs
Decreased clearance
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8. Diseases with increased incidence in
elderly
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Alzheimer's disease
Parkinsonism
Stroke
Vascular dementia
Visual impairment
specially cataracts
and macular
degeneration
Atherosclerosis
Arthritis
Heart failure
Fractures
Cancer
Diabetes
10. Renal Function Changes In Elderly
In the elderly, renal function progressively declines (intact
nephron loss)
At 50 years
G F R is ~
75%
At 75 years
G F R is ~ 50%
So drug
doses have to
be reduced
10
11. Hepatic Changes In Elderly
Reduction in hepatic microsomal drug metabolizing activity
Altered liver blood flow and its implications
There is also a
reduction in the
hepatic
microsomal drug
metabolizing
activity and liver
blood flow
Oral bioavailability
of drugs with high
hepatic extraction
is generally
increased
But the overall
effects on drug
metabolism are not
uniform
11
12. NOTE
Due to lower renal as well as metabolic
clearance, the elderly are prone to develop
cumulative toxicity while receiving
prolonged medication
12
14. Let’s see
an example
Dai l y d os e of s tr ep tom ycin i s
0 .75 g af ter 50 year s an d
0 .5 g af ter 70 year s of ag e com p ar ed to 1g f or youn g
ad ul ts .
14
16. Pharmacodynamic changes in elderly
Pharmac odynamic c hange s in the e lde rly have be e n le ss e x te nsive ly
studie d
Ev ide nc e of e nhanc e d e nd -organ re sponsive ne ss or "se nsitiv ity " to
medications with aging
Enhanced "sensitivity" may be
due
• Changes in receptor affinity
• Changes in receptor number
• Post-receptor alteration
• Age-related impairment of
homeostatic mechanisms Example:
decreased baroreceptor reflexes
Age-related changes:
• Increased
• sensitivity to sedation and
psychomotor impairment with
benzodiazepines
• level and duration of pain relief with
narcotic agents
• drowsiness with alcohol
• sensitivity to anti-cholinergic agents
• cardiac sensitivity to digoxin
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17. Drug Absorption and Distribution
Slower absorption due to reduced gut
motility as well as blood flow to intestines
Lesser plasma protein binding due to lower
plasma albumin
Increased or decreased volume of
distribution of lipophilic and hydrophilic
drugs respectively.
17
18. Cardiovascular System in the Elderly
A ge d are re lative ly intole rant
to digitalis.
The responsiveness of
adre ne rgic re c e ptor s to both
agonists and antagonists is
re duc e d in the e lde rly and
se nsitiv ity to othe r drugs also
may be alte re d
18
19. Cardiovascular drugs
Antihypertensive drugs
Systolic blood pressure increases with age in
western countries and in most culture in
which salt intake is high
Drugs used for it are Thiazides , calcium
channel blocker, beta blockers etc
ADRS related to these drug
Dizziness and falls
Orthostatic hypotension 19
20. Specific Considerations for Males
Due to prostatism in elderly
males, even mild
anticholinergic activity of the
drug can accentuate bladder
voiding difficulty
20
21. Adverse Drug Reactions in the Elderly
Elderly are also likely to be on multiple drug therapy for
hypertension, ischaemic heart disease, diabetes, arthritis
etc.
This increases many fold the chances or drug
interactions.
They are more prone to develop postural instability,
giddiness and mental confusion.
In general, the incidence of adverse drug reactions is
much higher in the elderly
21
22. Multiple Drug Therapy Challenges
Common conditions in the elderly that often
lead to polypharmacy include
Hypertension
Diabetes
Osteoarthritis
Cardiovascular diseases
Mental health disorders
Managing these conditions often requires
multiple medications
22
23. Polypharmacy
Polypharmacy refers to the simultaneous use
of multiple medications by a single
individual.
It can pose risks such as drug interactions,
side effects, and increased complexity in
managing health.
Regular review by healthcare professionals is
crucial to optimize medication regimens and
minimize potential harm.
23
25. CONCLUSION
Re nal De c line : Elde rly 's kidne y func tion drops,
GF R goe s from 75% at 50 ye ar s to 50% at 75
ye ar s.
Dose Adj ustments : Drug doses must be reduced
with age
A lte re d Handling: A ging affe c ts drug
absorption, prote in binding, and distribution,
le ading to pote ntial tox ic ity.
Adver se Reactions: Elderly face higher risk of
adve r se drug re ac tions due to re duc e d re c e ptor
re sponsive ne ss, pote ntial antic holine rgic
e ffe c ts, and inc re ase d me dic ation inte rac tions.
25