PHARMACOLOGY AND THE ELDERLY benzo药理学和老人苯.pptVIP

PHARMACOLOGY ANDTHE OLDER PATIENT David J. Mokler, Ph.D. Department of Pharmacology College of Osteopathic Medicine University of New England Learning Outcomes What are the physiologic changes that occur as we age that alter our response to drugs? What is the effect of these changes on the pharmacokinetics of commonly used drugs? What is anti-cholinergic syndrome? What are other classes of drugs that can cause cognitive impairment? What are the problems that are associated with the increased use of herbal medicines? What steps can we take to decrease the problems associated with polypharmacy? ALTERED PHYSIOLOGIC VARIABLES IN OLDER PATIENTS ALTERED PHYSIOLOGIC VARIABLES IN OLDER PATIENTS ALTERED PHYSIOLOGIC VARIABLESIN OLDER PATIENTS From Timiras, 1994 Diazepam Pharmacokinetics Klotz et al., J. Clin. Invest., 1975 Metabolism of Benzodiazepines Plasma Half-Lives in Young and Old Physiological Changes No significant changes in absorption Increased adipose tissue changes distribution of fat soluble drugs Decreased cardiac output Little effect on hepatic metabolism for most drugs Decreased renal excretion most significant Representative Drugs Showing Low Oral Availability Due to Extensive First-Pass Hepatic Elimination Alprenolol Amitriptyline Desipramine Dextropropxyphene Dihydroergotamine Diltiazem 5-flurouracil Hydralazine Labetolol Methylphenidate Metoprolol Morphine Nifedipine Nitroglycerin Pentazocine Propranolol Verapamil DRUGS WITH ANTI-CHOLINERGIC PROPERTIES Anti-psychotics: Chlorpromazine Anti-depressants: Amitriptyline, doxepin Anti-arrhythmics: Quinidine, disopyramide Anti-parkinson drugs: Benztropine, trihexyphenidyl Anti-spasmodics: Atropine Anti-histamine: Diphenhydramine, chlorpheneramine Proprietary sleep aids, cold medications Anti-Cholinergic Syndrome Systemic Tachycardia Warm, dry, flushed skin Decreased secretions Decreased bowel motility (constipation) Urinary retention Mydriasis, blurred vision Hyper-pyrexia Cardiac conduction problems