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POLYPHARMACIA

POLYPHARMACIA. Pat Borman, MD Advanced Training in Geriatrics. Case Example: Mr. Powers.

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POLYPHARMACIA

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  1. POLYPHARMACIA Pat Borman, MD Advanced Training in Geriatrics

  2. Case Example: Mr. Powers 72 yo new patient here with this son. He is a heavy smoker with COPD, HTN, CHF brings a bag full of medications. He is on an antihypertensive, an antidepressant started 2 y ago for impotence, for sleep difficulty he is taking his dead wife’s phenobarbital, while vacationing in Floirda a doctor starting cyclizine for dizziness, he says it calms him and helps with secretions. He reports dizziness with standing and opens his big brown bag. 1. Chlorthalidone 100 mg qod OTC’s 2. Potassium 20 mEq tid 9. Sinus antihistamine +decongestant 3. Oxitriphylline 200 mg qid 10. Sudafed for congestion 4. Docusate bid 11. Acetominophen for pain 5. Digoxin 0.25 mg qd 12. Dyphenhydramine for congestion 6. Methydopa 250 mg qid and sleep 7. Turbutaline 5 mg tid 8. Phenobarbital 60 mg qhs

  3. Adverse Drug Reactions ADRs • ADR Any unexpected functional change in the elderly consider drugs could be the culprit • 30% of out pt elderly have ADRs • 10-17% of hospital admissions are for ADR • What can we do do reduce ADR?

  4. Definition of Polypharmacy • Strictest: >5 medications • Looser: Irrational or inappropriate prescribing given pharmacokinetics, pharmacodynamics, knowledege of patient’s disease and functional state.

  5. Pharmacokinetics in Aging • Volume of Distribution • Reduced Total Body Water • Increased concentration of water soluble drugs • Metabolism • Decreased hepatic phase 1 metabolism • Less first pass and less biotransformation • Clearance • Decreased reanl plasma blood flow • Reduced renal excretion

  6. Pharmacodynamics • Drug effects in body • Altered effects due increased sensitivity • Benzodiazepines, opiates, warfarin • Drug-drug interactions • Furosimide&Gentamycin = Ototoxicity • H2 Blocker&anticholinergics = Delirium, Falls • Drug-disease interactions • Constipation: Anticholinergics, Calcium Channel Blockers, Narcotics

  7. DRUG CLASSES THAT PUT YOUR ELDERLY AT RISK • CARDIOVASCULAR • Disopyamide: CHF, anticholinergic • Calicium Channel Blockers: constipation, edema • Antihypertensives: orthostasis, renal insufficiency • PSYCHOACTIVES • Sedation, Delirium, Confusion, Falls, Anticholinergic • ANALGESIC

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