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11 Outline
Drug use among the elderly is disproportionately high b/c of increased severity of
illness, presence of multiple pathologies, excessive prescribing
Since the elderly generally suffer from chronic illnesses, the usual objective is to
improve quality of life and reduce symptoms, since cure is generally impossible
Absorption
percentage of oral dose that becomes absorbed does not change w/age
- rate of absorption changes (because of delayed gastric emptying and reduced
splanchnic blood flow)
- drug response may be somewhat delayed.
- Gastric acidity is reduced in the elderly and may alter absorption of certain drugs
(some drugs require high acidity to dissolve, so absorption may be decreased)
Distribution
4 major factors alter drug distribution in the elderly:
1. increased percent body fat (provides storage depot for lipid soluable drugs, so
plasma levels of these drugs are reduced, causing reduced response.)
2. decreased percent lean body mass – water soluble drugs become distributed in a
smaller volume, so concentration of these drugs is increased, causing more intense
effects
B/c liver fnc is diminished, the half lives of certain drugs may be increased,
prolonging responses.
Responses to oral drugs that ordinarily undergo extensive first pass metabolism
may be enhanced.
Excretion
Renal drug fnc and drug excretion undergo progressive decline in beginning
adulthood
** drug accumulation secondary to reduced renal excretion is most important cause
of adverse drug rxns in elderly
Decline in renal fnc is result of reductions in renal blood glow, GFR, active tubular
secretion and # of nephrons.
Creatinine clearance, not serum creatinine levels indicate proper renal fnc.
Reducing ADRs
Promoting adherence