Principles of Drug Therapy for the Elderly Patient

Acute Pain Management in the Emergency Department: Emphasis on NSAIDs

“…Although weight loss is generally thought to reduce most pain syndromes in the obese, a retrospective study of 11,719 bariatric surgery patients found that of the 8% on chronic opioid therapy before weight-loss surgery, 77% continued with opioid therapy one year after surgery (mean daily morphine equivalents 45.0 mg, 95% CI, 40.0 to 50.1 before surgery versus 51.9 mg, 95% CI, 46.0 to 57.8 after surgery) [45]. Moreover, opioid consumption patterns did not vary with relative weight loss (that is among those who lost 50% excess Table 1: Analgesic prescribing considerations in the elderly [134,135].…”

Pharmacy Practice, Research, Education, and Advocacy for Older Adults

“…54 Table 1 provides a list of commonly prescribed drugs that may be affected by pharmacokinetic changes in older adults. [54][55][56][57][58][59][60] Increasing gastric pH and decreased gastrointestinal transit time can change the absorption characteristics of certain dosage forms; however, the extent of absorption typically remains the same. Alterations in distribution can have effects on certain drugs.…”

“…Table 3 lists drugs that are commonly affected by pharmacodynamic changes in older adults. [54][55][56][57][58][59][60] …”

“…Table 2 provides a list of commonly prescribed drugs that require dosage adjustments or may not be effective or safe in older adults with kidney impairment. [54][55][56][57][58][59][60] In addition to changes that directly affect the pharmacokinetics of certain drugs, pharmacodynamic parameters are affected. 54 Changes in the central nervous system, resulting from decreased blood flow and receptor alterations, make older adults more sensitive to the actions and adverse effects of drugs acting on the brain.…”

Innovative Collaborative Practice to Optimize Pharmacotherapy for Frail Older Patients

“…Individuals with many medications tend to self-report poor health, are more likely to have cognitive impairment, and have lower functional status. 18 Because polypharmacy is highly prevalent among older adults who are frail, pharmacists working with patients in this age group have an opportunity to take a leadership role in monitoring for adherence, efficacy, and toxic effects and in helping those who are frail to manage their medications effectively. 19 Randomized controlled trials have shown that the involvement of pharmacists in the care of older persons not only improves the appropriateness of medication regimens but also reduces drug-related morbidity.…”