Abstract
Pharmacology involves not only pharmacokinetics but also pharmacodynamics and the principles affecting the proper selection, dosing, and monitoring of medications. Medications are our principal tools to maintain health, reverse illness, and prolong patient survival, hopefully with good quality of life. Yet medications can also cause serious illness and fail to have the desired effect if we use them incorrectly. As patients age, the manner in which they metabolize, eliminate, and respond to medications changes. Additionally, medications can be very expensive, and the cost to individual patients, hospitals, and our health system can become almost prohibitive. So the proper use of medications is critically important, and adjusting doses for changing patient physiology as they age is imperative.
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References
Preston J, Biddell B. The physiology of ageing and how these changes affect older people. Medicine. 2020;49:1–5.
Bhutti A, Morley J. The clinical significance of gastrointestinal changes with aging. Curr Opin Clin Nutr Metab Care. 2008;11:651–60.
Mangoni AA, Jackson SHD. Age-related changes in pharmacokinetics and pharmacodynamics: basic principles and practical applications. Br J Clin Pharmacol. 2004;57:6–14.
Bowie MW, Slattum PW. Pharmacodynamics in older adults: a review. Am J Geriatr Pharmacother. 2007;5:263–303.
Halli-Tierney AD, Scarborough C, Carroll D. Polypharmacy: evaluating risks and deprescribing. Am Fam Physician. 2019;100:32–8.
Hoel RWS, Giddings Connolly RM, Takahashi PY. Polypharmacy management in older patients. Mayo Clin Proc. 2021;96:242–56.
Scott IA, Hilmer SN, Le Couteur DG. Going beyond the guidelines in individualising the use of antihypertensive drugs in older patients. Drugs Aging. 2019;36:675–85.
Lau SWJ, Schlender J-F, Slattum PW, et al. Geriatrics 2030: develo** drugs to care for older persons—a neglected and growing population. Clin Pharmacol Ther. 2020;107:53–6.
Giral P, Neumann A, Weill A, Coste J. Cardiovascular effect of discontinuing statins for primary prevention at the age of 75 years: a nationwide population-based cohort study in France. Eur Heart J. 2019;40:3516–25.
ElDesoky ES. Pharmacokinetic-pharmacodynamic crisis in the elderly. Am J Ther. 2007;14:488–98.
Bristol-Myers Squibb. Eliquis® (apixaban tablets). Prescribing information. https://packageinserts.bms.com/pi/pi_eliquis.pdf. Accessed 31 Aug 2021.
https://www.fda.gov/drugs/drug-interactions-labeling/drug-development-and-drug-interactions-table-substrates-inhibitors-and-inducers. Accessed 30 Aug 2021.
https://drug-interactions.medicine.iu.edu/MainTable.aspx. Accessed 30 Aug 2021.
Beers MH, Ouslander JG, Rollinger I, et al. Explicit criteria for determining inappropriate medication use in nursing home residents. Arch Intern Med. 1991;151:1825–32.
American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society 2019 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2019;67:674–94.
Petty BG. Principles of evidence-based prescribing. In: McKean SC, Ross JJ, Dressler DD, Scheurer DB, editors. Principles and practice of hospital medicine. 2nd ed. New York: McGraw Hill; 2017. p. 56–61.
The INSIGHT-ESPRIT Study Group and SILCAAT Scientific Committee. Interleukin-2 therapy in patients with HIV infection. N Engl J Med. 2009;361:1548–59.
Alexander GC, Knopman DS, Emerson SS, et al. Revisiting FDA approval of aducanumab. N Engl J Med. 2021;385:769–71.
West CP. Outcomes, outcomes everywhere, nor any stop to think? J Gen Intern Med. 2011;26:1239–40.
Gale EAM. Troglitazone: the lesson that nobody learned? Diabetologia. 2006;49:1–6.
Martin AB, Hartman M, Lassman D, Catlin A. National health care spending in 2019: steady growth for the fourth consecutive year. Health Aff (Milwood). 2021;40:1–14.
Tichy EM, Hoffman JM, Suda KJ, et al. National trends in prescription drug expenditures and projections for 2021. Am J Health-Syst Pharm. 2021;78:1294–308.
www.nice.org.uk/Glossary?letter=Q#QALY. Accessed 30 Aug 2021.
Abernethy DR. An overview of the pharmacokinetics and pharmacodynamics of amlodipine in elderly persons with systemic hypertension. Am J Cardiol. 1994;73:10A–7A.
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Petty, B.G. (2023). Cardiovascular Pharmacology of the Older Patient. In: Leucker, T.M., Gerstenblith, G. (eds) Cardiovascular Disease in the Elderly. Contemporary Cardiology. Humana, Cham. https://doi.org/10.1007/978-3-031-16594-8_3
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DOI: https://doi.org/10.1007/978-3-031-16594-8_3
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