Geriatric Pharmacology

Geriatric Pharmacology — Clinical Compendium

How it begins

The elderly are, at the same time, the main consumer of medicines and their main victim. Aging simultaneously transforms pharmacokinetics (what the body does with the drug) and pharmacodynamics (what the drug does in the body), while pluripathology imposes polypharmacy. From this convergence, pharmacological iatrogenesis is born: a major—and largely preventable—cause of reactions...

What it covers

1. Why the elderly are pharmacologically different
2. · Epidemiology: the dimension of the problem
3. Pharmacokinetics: ADME in aging
4. · Absorption
5. · Distribution
6. · Hepatic metabolism
7. · Renal excretion
8. Kidney function and dose adjustment
9. · How to estimate glomerular filtration rate
10. · Drugs eliminated by kidneys that require monitoring
11. Pharmacodynamics and homeostasis
12. · Sensation changes in target organs
13. Polypharmacy
14. · Consequences of polypharmacy
15. · Factors that favor it
16. Adverse drug reactions (ADR)
17. · Risk factors for ADR in the elderly
18. · Drugs most frequently involved
19. Prescription cascade
20. · Classic examples
21. Drug interactions
22. · Drug-drug interactions
23. · Drug-disease interactions
24. · Drug-nutrient interactions and with "natural" products
25. Anticholinergic burden
26. · Drugs with anticholinergic activity (often unsuspected)
27. Adequacy criteria: Beers · STOPP/START
28. High-risk pharmacological groups
29. Therapeutic adherence
30. · Adherence barriers in the elderly
31. Deprescription and prudent prescription
32. · Structured deprescription process
33. · Principles of prudent prescription