Category Archives: Pharmacokinetics

Geriatric pharmacology: pharmacokinetics, polypharmacy and related topics

1111 This post collects different PowerPoint presentations on geriatric pharmacology. Some topics are recurrent, such as: physiological changes in pharmacokinetic parameters (absorption, metabolism, elimination), the concept of polypharmacy and classes of drugs that carry a higher risk of use in the elderly.

Geriatric drug therapy. By Linda Farho, Pharm.D

Lecture outline

  • Pharmacokinetics recall: Absorption, Distribution, Metabolism, Elimination. Bioavailability.
  • Effects of Aging on: absorption, metabolism, volume of distribution and the kidney.
  • Estimating GFR in the Elderly.
  • Determining creatinine clearance.
  • Pharmacodynamics.
  • Concepts related to an optimal pharmacotherapy.
  • Consequences of overprescribing.
  • Adverse drug events (ADE): most common medications, Beers criteria, patient risk factors for ADE.
  • Drug – drug interactions (DDI).
  • Drug – disease interactions.
  • Principles of prescribing in the elderly.
  • Preventing polypharmacy.
  • Enhancing medication adherence.
  • Clinical cases.

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Clinical Pharmacological Issues in the Elderly. By Charles A. Cefalu, MD

Lecture outline

  • Factors related to adverse drug reactions.
  • Changes of aging: liver, renal clearance, CNS.
  • Normal physiological changes in the organ systems.
  • Pharmaceutical agents that require hepatic metabolism.
  • The cytochrome system.
  • Drugs eliminated in the kidneys requiring dosage adjustment.
  • Aminoglycoside dosing in the elderly with impaired renal function.
  • Practical rule of thumb for dose adjustment.
  • Anticholinergic agents.
  • Clinical conditions that necessitate dosage adjustment in the elderly.
  • Anorexia and aging.
  • Screening for potential toxicity of prescription drugs: H2 blockers, beta blockers.
  • Innapropriate drugs: anticholinergics, indomethacin, propxyphene, trimethobenzamide and many others.

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The Bagful of Pills: Polypharmacy in the Elderly. By Oana Marcu, DO

Lecture outline

  • Definitions: polypharmacy, adverse drug reaction.
  • Economic consequences.
  • Geriatric prescription principles.
  • High risk medications in the elderly: Beers and Canadian criteria as consensus data.
  • High risk medications: analgesics (NSAIDs, narcotics, muscle relaxants) and narrow therapeutic index (digoxin, phenytoin, warfarin, theophylline, lithium) cardiovascular (antihypertensives, calcium channel blockers, propanolol, diuretics – see indications and mechanism of action- ), psychotropics (TCAs, antipsychotics, benzodiazepines , sedatives).
  • Avoiding polypharmacy: adjust the dose, review regimen regularly, educate.
  • Personal Health Records.
  • Clinical cases.

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Polypharmacy in the Elderly. By Rosemary D. Laird, MD

Lecture outline

  • Overview of polypharmacy.
  • The brown Bag.
  • Medications and the elderly.
  • Polypharmacy and the non-adherence.
  • Adverse drug reactions.
  • The role of the PCP.
  • Prescribing pearls.

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