Pharmacodynamics in Older Adults: A Review

Bowie, Mark W.; Slattum, Patricia W.

doi:10.1016/j.amjopharm.2007.10.001

Cited by 216 publications

(125 citation statements)

References 135 publications

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“…The initial anesthetic dose given to old animals was lower (40 mg kg −1 ip) than that given to young adults (60 mg kg −1 ip), and in general they require fewer anesthetic supplements during the experiments to suppress pain reflexes (see details in the online methods supplement). This difference has been attributed to pharmacokinetic issues in the elderly where the rapid intercompartimental clearance is 30% lower in the old when compared to young subjects, resulting in higher concentrations and more drugs available for distribution to the brain (Bowie and Slattum 2007). Anyway, no age differences in brain responsiveness were found: no change was detected in the action of GABA A receptor modulators like pentobarbital (Griffith et al 2000).…”

Section: Discussionmentioning

confidence: 79%

Carotid body function in aged rats: responses to hypoxia, ischemia, dopamine, and adenosine

Monteiro

Batuca

Obeso

et al. 2010

AGE

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The carotid body (CB) is the main arterial chemoreceptor with a low threshold to hypoxia. CB activity is augmented by A 2 -adenosine receptors stimulation and attenuated by D 2 -dopamine receptors. The effect of aging on ventilatory responses mediated by the CB to hypoxia, ischemia, and to adenosine and dopamine administration is almost unknown. This study aims to investigate the ventilatory response to ischemia and to adenosine, dopamine, and their antagonists in old rats, as well as the effect of hypoxia on adenosine 3′,5′-cyclic monophosphate (cAMP) accumulation in the aged CB. In vivo experiments were performed on young and aged rats anesthetized with pentobarbitone and breathing spontaneously. CB ischemia was induced AGE (2011) 33:337-350 DOI 10.1007 Scientific knowledge on the subject The functional ventilatory consequences of the morphological and molecular changes in the carotid body observed in aged animals, as well as the ventilatory effects of dopamine and adenosine in old animals, are still unknown.What this study adds to the field The carotid body's peripheral control of ventilation is not impaired by aging. The preservation of the inhibitory and excitatory effects on ventilation caused by exogenous dopamine and adenosine, respectively, should be taken into account in the therapeutic use of these amines and their agonists and antagonists in elderly people. by bilateral common carotid occlusions. cAMP content was measured in CB incubated with different oxygen concentrations. Hyperoxia caused a decrease in cAMP in the CB at all ages, but no differences were found between normoxia and hypoxia or between young and old animals. The endogenous dopaminergic inhibitory tonus is slightly reduced. However, both the ventilation decrease caused by exogenous dopamine and the increase mediated by A 2A -adenosine receptors are not impaired in aged animals. The bradycardia induced by adenosine is attenuated in old rats. The CB's peripheral control of ventilation is preserved during aging. Concerns have also arisen regarding the clinical usage of adenosine to revert supraventricular tachycardia and the use of dopamine in critical care situations involving elderly people.

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Section: Discussionmentioning

confidence: 79%

Carotid body function in aged rats: responses to hypoxia, ischemia, dopamine, and adenosine

Monteiro

Batuca

Obeso

et al. 2010

AGE

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“…45 Aging is associated with clinically important changes in pharmacokinetics 46 (Table 4) and pharmacodynamics. 47 Drug absorption is generally unchanged, but studies of drug distribution reveal increased plasma concentration of water-soluble drugs and increased half-life of fat-soluble drugs in older adults. Age-related changes in hepatic me- The pharmacodynamic change of most relevance to neuropathic pain treatment involves the central nervous system.…”

Section: Geriatric Pharmacotherapymentioning

confidence: 99%

Treatment Considerations for Elderly and Frail Patients With Neuropathic Pain

Schmader

Baron

Haanpää

et al. 2010

Mayo Clinic Proceedings

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Neuropathic paiN treatmeNt iN elderly, Frail patieNtsFor personal use. Mass reproduce only with permission from Mayo Clinic Proceedings a .limb amputation, 8 and stroke. 9 Indeed, the incidences of postherpetic neuralgia, painful diabetic neuropathy, and phantom limb pain are all several times higher in patients 75 years or older than in patients between 45 and 59 years. 10 Furthermore, these and other diseases commonly coexist in older patients, which results in patients with neuropathic pain frequently having complex drug regimens that complicate pharmacotherapeutic choices.Given the large number of older persons with neuropathic pain and their complex health problems, the objective of this article is to review how aging and frailty affect the treatment of older adults with neuropathic pain. The specific principles and topics include aged heterogeneity, multimorbidity, functional status, geriatric pharmacotherapy, and limitations in the evidence base for treatment decisions for older adults. Treatment Considerations for Elderly and Frail PatientsWith Neuropathic Pain Currently, an estimated 38 million individuals 65 years or older live in the United States, and more than 11 million of these individuals are 80 years or older. Older people are at high risk of neuropathic pain because many diseases that cause neuropathic pain increase in incidence with age. Depending on their underlying health, older adults with neuropathic pain may have to cope with multiple coexisting diseases, polypharmacy, and impaired functional ability. The objective of this article is to review how aging and frailty affect the treatment of older adults with neuropathic pain. Specific topics reviewed include the complexity of treatment decisions in older patients due to aged heterogeneity, multimorbidity, and polypharmacy; selection of treatment in an effort to maximize patients' functional abilities in addition to relieving their pain; more careful dosing (usually lower) and monitoring of pharmacotherapy relative to younger patients due to age-related changes in pharmacokinetics and pharmacodynamics; and underrepresentation of older adults in clinical trials of neuropathic pain treatments, which further compromises physicians' ability to make informed treatment decisions.Mayo Clin Proc. 2010;85(3)(suppl):S26-S32 ADL = activity of daily living; IADL = instrumental ADL; NSAID = nonsteroidal anti-inflammatory drug

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“…Both drugs have similar mechanisms of action and adverse effects, 27 which often are pronounced in older patients because of age-related changes in pharmacokinetics and pharmacodynamics. 14,28,29 Benzodiazepines and Z-drugs have prolonged elimination half-lives in older patients, which may lead to accumulation of the drug.…”

Section: Discussionmentioning

confidence: 99%