Drugs In Elderly Patients Research Articles

Phenazopyridine-induced hemolytic anemia

An elderly inan was seen with hemolytic anemia due to the urinary tract analgesic, phenazopyridine hydrochloride. The inechanisins underlying this toxic reaction are presented. Cautious use of this drug in elderly patients and in those with renal insufficiency is emphasized.

Rational therapeutics in the elderly

The potential for altered responsiveness to drugs in elderly patients together with their high frequency of multiple disease states for which drug therapy might be indicated makes it important to define certain basic principles of prescribing for them in order to obtain maximum efficacy with minimum unwanted effects. Many diseases from which the elderly suffer do not require drug treatment and, if it is required, the decision should be made in light of the pharmacokinetic and pharmacodynamic characteristics of the alternatives, the increased potential of certain drugs to produce adverse effects in the elderly and a regular review of the need for continued medication. In order to improve compliance with prescribing instructions, the minimum number of drugs and doses should be prescribed, the size, shape and colour of tablets and capsules should also determine choice, and attention paid to packaging and labelling. The methods by which the patient living at home can manage his/her medication effectively should be carefully considered.

Gastrointestinal consequences of treatment with drugs in elderly patients.

The aging process affects many organs of the gastrointestinal tract. The most common effect is decreased motility, which may result in patient discomfort and various alterations in absorption. Concurrent pathologic conditions, common in the elderly, can lead in turn to the use of many pharmaceuticals, either alone or in combination. Untoward reactions to these drugs, when they occur, are often manifest in the gastrointestinal tract. Agents that may cause gastrointestinal bleeding include aspirin, corticosteroids, anticoagulants, antimetabolites, and agents used in cancer chemotherapy. Ethanol or aspirin or other drugs can cause erosive gastritis.

Four-week tolerance study of chlormezanone for the treatment of insomnia in the elderly.

A 4-week study of chlormezanone was carried out in thirty-two patients admitted to a geriatric ward and requiring regular night sedation. Two patients required 400 mg nightly, the remainder only 200 mg nightly. The duration and quality of sleep, and frequency of awaking refreshed, all improved during chlormezanone therapy. There was no deterioration in mental agility test performance. There were no serious side-effects, no significant changes in blood urea or liver function tests, and no evidence of drug accumulation. It is concluded that chlormezanone appears to be a well tolerated drug for elderly patients with sleep disturbance meriting further controlled evaluation.

Study of fatal bone marrow depression with special reference to phenylbutazone and oxyphenbutazone.

The histories of 269 patients whose death certificates did not mention a drug as the cause of aplastic anaemia or agranulocytosis were investigated. Eighty-three deaths were probably caused by drugs, the most common cause of aplastic anaemia being treatment with phenylbutazone (28 deaths) and oxyphenbutazone (11 deaths). Thirteen out of 17 deaths from agranulocytosis were attributed to co-trimoxazole treatment. A separate survey of general practitioners' prescriptions enabled the mortality to be estimated. With the addition of one death due to oxyphenbutazone and four deaths due to phenylbutazone that were reported independently to the committee, the mortality from oxyphenbutazone was 3-8 per 100 000 and from phenylbutazone 2-2 per 100 000. With phenylbutazone the rates varied from under 1 death per 100 000 for men aged under 65 years to 6 per 100 000 for women aged 65 and over. Small numbers precluded estimates for oxyphenbutazone in these subgroups, although a similar trend was suggested. No particular indication for treatment seems to carry a higher risk, the main concern being the use of these two drugs in elderly patients.

The Use of Psychoactive Drugs in Elderly Patients with Psychiatric Disorders: Survey Conducted in Twelve Veterans Administration Hospitals

A survey conducted at 12 VA hospitals included the collection of detailed information on the use of psychoactive drugs in 1,276 elderly psychiatric patients. On the day of the survey, 61 per cent of the patients were receiving psychoactive drugs. Prescription practices relating to the choice of drugs, prevalence of drug use, dosage, combination drug preparations, and antiparkinson agents are discussed in terms of such factors as the patient's age and the diagnosis. Also discussed is the literature on psychoactive drugs, particularly as it pertains to elderly populations.

CONTROLLED COMPARISON OF FOUR SEDATIVE DRUGS IN ELDERLY PATIENTS.

CONTROLLED COMPARISON OF FOUR SEDATIVE DRUGS IN ELDERLY PATIENTS.

Progressive loss of protective reflexes in the airway with the advance of age.

Aspiration pneumonia is a common and serious complication, especially among elderly patients. By using randomized concentrations of ammonia gas as an irritant, the threshold of the protective airway reflex was determined in 103 subjects. The end-point was a brief stop in the inspiration as recorded on a metabolic spirometer. The median threshold was found to increase sixfold from the second to the eighth and ninth decades of life. This decrease in sensitivity explains, in part, why silent tracheal aspiration seems to occur oftener in older people. The protective airway reflex can be further depressed by injudicious use of depressant drugs in elderly patients. The effects of various drugs on the reflex can be determined readily by applying the method here described.