老年病学英文课件：06 老年人用药.ppt

* * Because of the great interindividual variability, need to optimally individualise drug therapy Consider phamacokinetic and pharmacodynamic changes observed in normal aging Consider the accompanied diseases and the organ functions Begin with low dose, maintain at the minimum effective dose Follow up frequently, evaluate efficiency and safety, modify dose when need. Individulize drug doses * * Manner of usage Time of administration the circadian rhythms of disease and symptoms pharmacokinetics pharmacodynamics before or after meal Patient education---explain the benefits and risks associated with the use of a new therapy Simplify description * * Discontinue therapy Consider adverse drug events as a potential cause for any new symptom。 Prescribing cascade. Rochon PA, et al. Drug therapy. Lancet. 1995;346:32. * * Reading package insert of drugs Older adults are underrepresented in clinical trials, esp. patients older than 85 years, so the “dosage” in the package insert pro- bably is not suitable for older patients standard for defining frequency of adverse reaction Recommended by Organizations of Medical Science/CIOMS very common ≥ 10％ common 1％-10％ uncommon 0.1％～ 1％ rare 0.01％～ 0.1 very rare <0.01％ Notice the “precautions” and “drug-drug interactions” * * Medication Reconciliation Medication reconciliation is the process of comparing a patient’s medication prescriptions to all the medi- cations that the patient has been taking, done to avoid medication errors. * * Measuring the quality of drug prescribing The most widely used criteria for the assessment of inappropriate prescribing ---- the Beers criteria. developed in 1991 to evaluate inappropriate prescribing in nursing home residents, revised in 1997 and again in 2003 to make them more r