Drug Treatment In Elderly Patients Research Articles

УЧЕТ ИНДЕКСА КОМОРБИДНОСТИ ПРИ ПРОВЕДЕНИИ ПРОТИВООПУХОЛЕВОЙ ЛЕКАРСТВЕННОЙ ТЕРАПИИ У ПАЦИЕНТОВ ПОЖИЛОГО И СТАРЧЕСКОГО ВОЗРАСТА С КОЛОРЕКТАЛЬНЫМ РАКОМ (ОБЗОР ЛИТЕРАТУРЫ)

The problem of treating elderly patients is one of the most pressing in modern clinical medicine. Colorectal cancer is one of the main causes of mortality from malignant neoplasms in Russia and other developed countries. At the same time, the incidence of tumors of the colon and rectum steadily increases with age. Before starting treatment for elderly patients, it is necessary to carefully weigh the potential risks and the possibility of achieving positive results of antitumor therapy. Objective: To summarize the literature on the use of a comprehensive geriatric assessment, including the Cancer and Aging Research Group (CARG) toxicity assessment, to predict the risk of adverse events during anticancer drug treatment in elderly patients diagnosed with colorectal cancer. Materials and methods: The search for scientific sources was carried out in PubMed / Medline / UpToDate using the following keywords: “malignant tumors”, “metastatic colorectal cancer”, “senile age”, “antitumor drug therapy”. The time horizon covered 2016–2023. Using a time filter, the most relevant and innovative research papers on the issues of chemotherapy treatment of elderly and senile patients were selected. Results: Most current evidence demonstrates the importance of performing a comprehensive geriatric assessment (CGA), Cancer and Aging Research Group (CARG) toxicity assessment in elderly and geriatric patients. Information obtained from geriatric assessment should be used to predict and manage treatment toxicity. And also for assessing and predicting overall survival. Activities based on CGA can reduce the toxicity of chemotherapy, improve the quality of life of patients, and increase compliance with medical recommendations. Undoubtedly, a comprehensive geriatric assessment (CGA) can help achieve the necessary balance between the potential effectiveness and adverse events of chemotherapy. The choice of treatment tactics for an elderly and senile cancer patient should be based on the patient’s functional status (PS), general somatic status according to the ECOG scale, and the risk of toxicity according to the CARG scale. In the presence of colorectal cancer, patients with good functional status who need antitumor systemic effects can be prescribed polychemotherapy with FOLFOX, XELOX, FOLFIRI doublets with the addition of targeted drugs: bevacizumab or cetuximab (depending on the results of gene profiling of the tumor). Patients who are not candidates for polychemotherapy in standard doses, who have a general somatic status on the ECOG scale of 1-2 and an average risk of developing toxicity of grade 3 on the CARG scale, can undergo PCT with FOLFOX, XELOX, FOLFIRI doublets with a reduction in the starting dose by 20%, or monochemotherapy with antimetabolites: capecitabine, 5-fluorouracil; topoisomerase I inhibitor irinotecan. Patients with poor functional status, general somatic status on the ECOG scale 3-4, and a high risk of developing toxicity on the CARG scale are not candidates for systemic combination chemotherapy. Particular attention should be paid to maintenance therapy in this subgroup of patients. However, if the decrease in PS level is directly related to malignancy and PS ≥2, the possibility of monochemotherapy by infusion of a combination of 5-fluorouracil and leucovorin FU/LV can be evaluated.

The Possibility of Therapeutic Drug Monitoring of the Most Important Interactions in Nursing Homes.

BackgroundTherapeutic drug monitoring is a relevant tool in drug treatment of elderly patients. The aim of this study was to assess the possibility of therapeutic drug monitoring of the most important potential interactions in nursing homes.MethodsA material of prescribed drugs to 446 patients in three nursing homes in Bergen, Norway from a single day in March 2016 was analysed. Clinically relevant drug interactions (pharmacodynamic or pharmacokinetic) were identified and classified with Stockley`s Interaction Alerts. The most important interaction among several in each patient were ranked by recommended action > severity > evidence according to Stockley`s. The possibility of therapeutic drug monitoring of drug combinations involved in the most important interactions was retrieved from a database of all laboratories performing clinical pharmacology in Norway (the Pharmacology Portal).ResultsTwo or more drugs were used by 443 (99.3%) of 446 patients. Three-hundred and eighty-four patients (86.1%) had > 1 interaction. About 95% of the most important interactions were pharmacodynamic. In 280 (72.9%) of these interactions, Stockley`s recommended adjust dose or monitoring. Among the 384 most important interactions, 93% involved one drug and 41% involved two drugs available for therapeutic drug monitoring.ConclusionIn this pilot study, therapeutic drug monitoring was possible in the majority of the most important interactions in Norwegian nursing homes. This option is of importance since adjust dose or monitoring were frequently recommended actions associated with these interactions.

P5543Features of treatment and outcomes in elderly patients. Results of the KRACS register

Abstract Purpose To evaluate the features of treatment and outcomes in elderly patients with acute coronary syndrome. Methods The elderly group comprised 2385 (28.9%) patients ≥75 years of the 8249 patients enrolled in the KRACS registry. Results When comparing patients of different ages, it was shown that among the elderly, dyspnoea was the most common manifestation of ACS, 9% vs 4% (p=0.015), they were less often hospitalized in “invasive” hospitals - 36% vs 49% (p=0.003), At admission, they often had the class Killip ≥ II - 36% vs 17% (p<0.001), a high risk for the GRASE-68% vs 30% (p<0.001). In addition, in elderly patients significantly lowered levels of Hb and increased creatinine were detected more often. Drug treatment of elderly patients was characterized by less frequent use of ticagrelor - 3% vs 21% (p<0.001), LMWH or fondaparinux - 4% vs 12% (p=0.004). Thrombolytic therapy in STEMI in the elderly was more often streptokinase - 30% vs 18% (p=0.04), less often - tissue activator plasminogen - 2% vs 10% (p=0.03). The frequency of performing any invasive interventions for any type of ACS in elderly patients was significantly lower - 16.7% vs 46.3% (p<0.0001), and the incidence of fatal outcomes during hospitalization for any type of ACS was significantly higher - 16, 0% vs 6.1% (p<0.0001). When assessing the incidence of fatalities in different facilities, it was found that STEMI, patients ≥75 years old hospitalized in “invasive” hospitals died significantly less frequently than when they got into “non-invasive” hospitals - 15.6% vs 50.0% (p=0.013). At the same time, among patients <75 years hospital mortality in “invasive” and “non-invasive” hospitals was not significantly different - 14.7% vs 9.9% (p=0.50). There was also a clear trend towards a higher incidence of deaths among elderly patients who were left without PCI, compared with those who had been intervened. In patients <75 years, this trend was absent. Conclusion Thus, the results obtained indicate that elderly patients, with a higher risk and worse outcomes, receive treatment that is less consistent with the requirements of modern guidelines for the treatment of ACS. Important factors associated with better outcomes in elderly patients is their hospitalization in “invasive” hospitals and the implementation of PCI.

P6260ACS-group 75+: real clinical practice

Abstract Purpose to evaluate the features of treatment and outcomes in elderly patients with acute coronary syndrome. Methods The elderly group comprised 2385 (28.9%) patients ≥75 years of the 8249 patients enrolled in the KRACS registry. Results When comparing patients of different ages, it was shown that among the elderly, dyspnoea was the most common manifestation of ACS, 9% vs 4% (p=0.015), they were less often hospitalized in “invasive” hospitals - 36% vs 49% (p=0.003), At admission, they often had the class Killip ≥ II - 36% vs 17% (p<0.001), a high risk for the GRASE-68% vs 30% (p<0.001). In addition, in elderly patients significantly lowered levels of Hb and increased creatinine were detected more often. Drug treatment of elderly patients was characterized by less frequent use of ticagrelor - 3% vs 21% (p<0.001), LMWH or fondaparinux - 4% vs 12% (p=0.004). Thrombolytic therapy in STEMI in the elderly was more often streptokinase - 30% vs 18% (p=0.04), less often - tissue activator plasminogen - 2% vs 10% (p=0.03). The frequency of performing any invasive interventions for any type of ACS in elderly patients was significantly lower - 16.7% vs 46.3% (p<0.0001), and the incidence of fatal outcomes during hospitalization for any type of ACS was significantly higher - 16, 0% vs 6.1% (p<0.0001). When assessing the incidence of fatalities in different facilities, it was found that STEMI, patients ≥75 years old hospitalized in “invasive” hospitals died significantly less frequently than when they got into “non-invasive” hospitals - 15.6% vs 50.0% (p=0.013). At the same time, among patients <75 years hospital mortality in “invasive” and “non-invasive” hospitals was not significantly different - 14.7% vs 9.9% (p=0.50). There was also a clear trend towards a higher incidence of deaths among elderly patients who were left without PCI, compared with those who had been intervened. In patients <75 years, this trend was absent. Conclusion thus, the results obtained indicate that elderly patients, with a higher risk and worse outcomes, receive treatment that is less consistent with the requirements of modern guidelines for the treatment of ACS. Important factors associated with better outcomes in elderly patients is their hospitalization in “invasive” hospitals and the implementation of PCI.

Effect of Potentially Inappropriate Medication on Treatment Adherence in Elderly with Chronic Illness

Non-adherence to treatment has been associated with poor clinical outcomes, especially in vulnerable population like, the elderly. In general, the adherence to medication and use of a potentially inappropriate medication (PIM) may range from 47 to 100% and 20 to 25% respectively, in elderly. PIM is associated with increased risk of adverse drug reactions (ADR) which is a recognized determinant of adherence. The present study was taken up with the primary objective of exploring the influence of potentially inappropriate medication on adherence to drug treatment in elderly patients with chronic illnesses. This cross-sectional study was carried out in the out-patient department of a tertiary care hospital, on a convenience sample of 425 elderly patients. Medication adherence was assessed using the Morisky Medication Adherence Scale. PIM was assessed as per the American Geriatric Society (AGS) Beers Criteria of 2015. Ordinal regression method was used to analyze the relationship between the ordinal outcome variable (adherence) and the explanatory variables. The study observed that about 48% of the elderly patients were found to be non-adherent to treatment. An inappropriate drug was prescribed in 23.8%. Elderly patients with a potentially inappropriate medication were twice likely be non-adherent to treatment than those without a PIM (OR: 2.089 with CI: 1.277-3.419, p = 0.003). The present study concluded that potentially inappropriate medication is an important predictor of medication adherence in elderly. Since, high adherence level to medication among patients is widely reported to be associated with higher treatment efficacy, identifying the factors that lead to poor medication adherence is essential for the success of a therapy. Prescribers should carefully assess the appropriateness of medications in elderly to improve their adherence to therapy.

Improvement of drug treatment in elderly patients, through the collaborative work between pharmacists and physicians

Introduction : Pharmacists have been progressively included in health care teams delivering integrated care. With the development of Pharmaceutical Care, pharmacists provide direct medication-related care with the aim of improving patient’s life quality. However, even thought these progresses (especially in hospitals), most day to day work in integrated care is centered on physician’s and nurses. Benefits of integrated care are higher in the patients with most complex health care needs, such as older people. This group of population is characterized by its frailty, comorbidities and polypharmacy; therefore problems related with medication (PRM), are more frequent and have more serious impact. Our Group is specialized in giving health care to older people at different levels: primary, nursing homes, long term care, home care; areas where the participation of pharmacist in the integrate care is usually underdeveloped. Therefore, there is less evidence on the benefits derived from pharmacist’s intervention; compared with other health care institutions such acute care hospitals. From our Pharmacy Service, we have been working in the incorporation of the pharmacist as a member of the care team in order to improve outcomes in our patients through the management of medication and PRM. Short description of practice : We have implemented a program to improve drug treatments in our patients, through pharmacist’s interventions derived from medication reviews and prescription validation. The program has been established in two heath systems, managed by our Group: - Long term care and subacute care Hospitals (HSS): HSS Mutuam Guell (165 beds) and HSS Mutuam Girona (103 beds). - Health care support teams for nursing homes: EARs (Formed by physicians and nurses) In the two Hospitals, pharmacists’ can make interventions at different moments of the patient process: Admission, during the hospital stay and at discharge. In EARs, pharmacists make at the admission of the patient in the nursing home. Drug related problems detected are communicated to the physician through email or telephone. Drug related problems are recorded in a database using Microsoft Excel® using the ASHP (American Society Health-System Pharmacists) classification, as well as answers or lack of it from physicians. Improvement in drug treatments is evaluated using the MAI (Medication Appropriateness Index) Key findings : Period considered: June 2014-2015 Demographic data: Mean age HSS 80.7 years (70% female) and EARs 84.8 years (59% female). In both cases more of the 69% of patients taking ≥ 9 drugs. Total of treatments reviewed by pharmacists: 3671 in EARs and 2176 in HSS. Have been conducted 4115 interventions in EARs (1.94 interventions/patient) and 2534 in HSS (2.43 interventions/patient). The degree of answer was 44% in EARs and 79% in HSS. Of the interventions/recommendations answered they were accepted in an 84 % (EARs) and 72% (HSS). More frequent PRM found where similar in HSS and EAR: Inappropriate dose, dosage form, schedule, route of administration, or method of administration; Medication with no indication: Condition for which no medication is prescribed and Problems are arising from the financial impact of therapy MAI values after implementation by physicians of pharmacist’s recommendations in EARs decreased from 4, 4 to 2.68 (p Hightlights : The implication of pharmacists in the medication reviews of those patients leads to a quality improvement of the prescriptions; as MAI show (p One of the main problems is the low degree of physician’s answer, particularly in EARs. This is probably due to that in HSS - Pharmacists in HSS are closely working with physicians since a longer time, so physicians are more aware how to manage recommendations and what to expect from the pharmacist. - They work in the same building, making communication easier. Moreover, HSS physicians are independent in applying the recommendations of pharmacists, whereas in EARs, some nursing homes have their own physicians, so our team’s physician has to agree some of the changes proposed. However, we have noted that since we started the program the response tendency is increasing deriving in part from day to day, working together, exchanging opinions and explaining the aim of our work. Conclusions : - The program has lead to an increase in the appropriateness of drug use in geriatric patients. - We have been able to apply it to two different kind of health care levels. Therefore, we think that in the future it can also be extended to home care, etc. - It is important to give Information and formation to all heath care professionals about the benefits of collaborative work with pharmacists.

Outcome of initial antiepileptic drug treatment in elderly patients with newly diagnosed epilepsy

PurposeA study was carried out to assess the outcome of initial antiepileptic drug (AED) monotherapy in elderly patients with newly diagnosed epilepsy and to investigate the cumulative probabilities of ≥2- and ≥5-year complete seizure remission and the factors that may have an effect on the outcome of AED treatment and the response to successive AED regimens. MethodsFrom the medical records of Kuopio University Hospital, Finland, the researchers identified a community-dwelling cohort of elderly subjects (aged 65 or above at the time of diagnosis; n=529) with newly diagnosed epilepsy. The seizure outcome and the effect of initial prescription of AEDs were retrospectively studied. ResultsAll told, 336 (64%) of the patients used the initial AED for the whole follow-up period, while the treatment was changed for 193 (36%) of the patients. In total, 456 (86%) of the 529 patients were treated with monotherapy until the end of follow-up. Four per cent of the patients developed refractory epilepsy. The response to the second monotherapy after failure of the first monotherapy was similar between patients whose treatment failed for reason of intolerable side effects and those showing failure due to inadequate seizure control. The estimated cumulative probability of achieving ≥2 years’ remission was 83%, and that for achieving ≥5 years of remission was 79%. Early response to treatment was a statistically significant predictor of remission. ConclusionThe prognosis of seizures in elderly patients with newly diagnosed epilepsy is good, and most patients can be successfully treated with the first AED. Patients who do not become seizure-free within the first year may be at risk of displaying a drug-resistant seizure disorder.

PS-020 Pharmacotherapy optimisation in healthcare transitions

BackgroundMedicines reconciliation in healthcare transitions may help prevent adverse drug events and improve patient safety.PurposeTo describe and review the system for medicines reconciliation in order to improve drug treatment in...

Besonderheiten Rheumatologischer Pharmakotherapie im Alter

Faktoren wie Multimorbidität und Multimedikation, häufige Nierenfunktionseinschränkung und weitere pharmakokinetische Besonderheiten sorgen dafür, dass die medikamentöse Behandlung des geriatrischen Rheumapatienten oft nicht ganz unkompliziert ist. Durch die Vielfalt der heutigen Behandlungsmöglichkeiten gelingt es jedoch dennoch, jeden älteren Rheumatiker therapeutisch gut zu versorgen. Leider werden in dieser Altersstufe kaum kontrollierte Studien durchgeführt, sodass das Vorgehen eher empirisch als evidenzbasiert begründet ist. Grundsätzlich empfiehlt sich ein vorsichtigeres Vorgehen bei Anfangsdosierung und Dosissteigerung. Problemlos sind in der Regel Glucocorticoide einsetzbar, ebenso sind milde Basistherapeutika wie Hydroxychloroquin und Sulfasalazin, aber auch Leflunomid einsetzbar. Das ansonsten in der Rheumatologie vielverwendete Methotrexat steht hingegen nur bei guter Nierenfunktion zur Verfügung. Bei hochaktiver RA kann durchaus auf Biologika zurückgegriffen werden, die auch in dieser Altersstufe gut wirken, allerdings mit höherem Infektionsrisiko verbunden sind.

What a waste

What a waste

Perception of potentially inappropriate medication in elderly patients by Slovak physicians

The aim of the present study was to determine the risk perception of potentially inappropriate drug treatment of elderly patients by Slovak physicians. In Slovakia, a list of such drugs is not available. The study sample consisted of 600 patients aged > or =65 years hospitalized at the Department of Internal Medicine in a Slovak general hospital between 1 December 2003 and 31 March 2005. The use of potentially inappropriate drugs at the time of hospital admission and discharge was compared. Potentially inappropriate drug use was defined by Beers 2003 criteria. In addition, 206 physicians were asked to mark the drugs that they considered potentially inappropriate for elderly patients out of a list provided in a questionnaire analysis. Out of 600 patients 20.2% and 20% were treated with at least one potentially inappropriate drug at the time of hospital admission and discharge, respectively. Hospitalization had no significant influence on the number of potentially inappropriate medicines used. The most frequently prescribed potentially inappropriate drugs were digoxin >0.125 mg/day and ticlopidine. Out of 206 responding physicians only 4.9% considered ticlopidine as potentially inappropriate for elderly patient. On the other hand, more than 20% of respondents were aware of the potential inappropriateness of amitriptyline, diazepam and chlordiazepoxide. Mentioned drugs were observed in less than 2% of study population (n = 600). The results of the questionnaire analysis in physicians as well as the prevalence of potentially inappropriate medication demonstrate that Slovak clinicians are aware of the risk of certain treatments in elderly patients.

Benefits of antihypertensive drug treatment in elderly patients with isolated systolic hypertension.

Isolated systolic hypertension affects over 15% of all people older than 60 years. In the elderly, systolic hypertension is a major modifiable cardiovascular risk factor. Systolic blood pressure is associated with higher risk of an adverse outcome, whereas diastolic blood pressure is inversely correlated with total mortality, independent of systolic blood pressure, highlighting the role of pulse pressure as risk factor. Three placebo-controlled outcome trials on antihypertensive drug treatment in older patients with isolated systolic hypertension have been published: the Systolic Hypertension in the Elderly Program (SHEP), the Systolic Hypertension in Europe (Syst-Eur) Trial and the Systolic Hypertension in China (Syst-China) Trial. These three trials demonstrated the benefit of antihypertensive drug treatment. A meta-analysis was performed by pooling the patients from these three trials with a subset of patients with isolated systolic hypertension from five other trials in the elderly. Antihypertensive treatment based on a calcium-channel blocker may provide additional benefits in diabetic patients and in the prevention of dementia and renal dysfunction. The pooled results of 15693 older patients with isolated systolic hypertension prove that antihypertensive drug treatment is justified if on repeated clinic measurements systolic blood pressure is 160 mmHg or higher.

Drug treatment of elderly patients with acute myocardial infarction: practical recommendations.

Aspirin (acetylsalicylic acid) should be administered to patients on day 1 of an acute myocardial infarction (MI) and continued indefinitely. Early intravenous beta-blockade should be used during acute MI. beta-blockers should be continued indefinitely. Angiotensin-converting enzyme (ACE) inhibitors should be used in patients with acute MI with ST-segment elevation in two or more anterior precordial leads. ACE inhibitors should be used during and after acute MI in patients with chronic heart failure (CHF) or with a left ventricular ejection fraction < or =40%. There are no class I indications for using calcium channel antagonists during and after acute MI. Intravenous heparin should be used in patients with acute MI undergoing coronary revascularisation and in patients at high risk for systemic embolisation. Enoxaparin should be used in patients with non-Q-wave MI. Thrombolytic therapy should be considered in patients with acute MI with ST-segment elevation in contiguous leads of a 12-lead electrocardiogram or with left bundle branch block. Platelet glycoprotein IIb/IIIa inhibitors should be administered intravenously as an adjunct to heparin and aspirin in patients with non-Q-wave MI. Intravenous nitroglycerin should be used: (i) for the first 24 to 48 hours in patients with acute MI and CHF, large anterior MI, persistent ischaemia or hypertension; and (ii) continued beyond 48 hours in patients with recurrent angina pectoris or persistent pulmonary congestion. Long-acting nitrates should be given after MI, along with beta-blockers, to patients with angina pectoris. There are no class I indications for using intravenous magnesium during acute MI. The routine use of antiarrhythmic drugs other than beta-blockers during and after acute MI is not recommended.

Practical aspects of drug treatment in elderly patients with mobility problems.

Elderly people with impaired mobility frequently experience difficulty with medication administration and compliance. Many medications are dispensed in packages or in containers which are difficult to access by older people with disabilities. Attending a medical centre, activating an inhaler, applying eyedrops or opening medication containers can prove major obstacles to medication compliance for older people with impaired function. Assessment of each patient's ability to physically comply with medication regimens by the physician is therefore recommended. Contact with the care giver or support person should also be made where appropriate. Compliance aids such as some calendar packages for medications, metered dose inhalers (MDIs) or eyedrop aids should be prescribed where indicated. Because of their close contact with many elderly patients when dispensing, pharmacists can also play an important role in ensuring adherence with medication regimens. Some medications may improve mobility as seen in the treatment of Parkinson's disease whereas other medications such as phenothiazines may impair mobility and contribute to falls. Several drug classes including antipsychotics, antidepressants, antihypertensives and benzodiazepines have been recognised as having an association with falls and impaired mobility. Multiple medications have also been found to be a risk factor in falls. Medications should be reviewed regularly and rationalised where possible. If mobility problems or unexplained falls are occurring, medications should be closely scrutinized as they may be responsible. Where possible, domiciliary visits for older people should be undertaken by health professionals as they often provide critical information about a patient's functional status, their medication compliance and their ability to cope at home. Emphasis must be placed on older people maintaining their independence and mobility. This is best achieved through a multidisciplinary approach.

Role of Atypical Antipsychotics in the Treatment of Psychosis and Agitation Associated with Dementia

The drug treatment of elderly patients is challenging because of the various pharmacokinetic and pharmacodynamic changes associated with increasing age, and the frequent comorbid medical conditions found in and multiple concurrent medications used by this population.

Changes in drug treatment after discharge from hospital in geriatric patients.

To ascertain changes in drug treatment of elderly patients after discharge from hospital and to identify areas of communication which may require improvement. Follow up of patients six to 14 days after discharge, when the drugs supplied by the hospital should have run out and a further supply obtained from the general practitioner. Patients were also asked about information supplied to them by health care professionals during their hospital stay. 50 elderly patients discharged from five geriatric wards (mean age 76.9 years). Sunderland District Health Authority. Drugs taken after discharge from hospital. After returning home the drug regimen of 45 patients differed from that prescribed on discharge from hospital, with 11 patients taking a different dose, 10 having stopped drugs, and 20 taking new drugs. Possible influencing factors included an incomplete drug history, the continuation of drugs taken before hospital admission, and changes in the prescription not attributable to a conscious clinical decision. Lack of information also contributed; 46 patients could not recall being told when to take drugs before discharge. Closer communication is needed between hospital and community health care professionals to ensure that patients are informed about their discharge prescription and continuation of treatment.

Reduced muscarinic receptor plasticity in frontal cortex of aged rats after chronic administration of cholinergic drugs

Age-related differences in muscarinic receptor plasticity were observed in young, adult and senescent Fischer 344 rats (3, 9 and 27 months old, respectively) following the chronic, intracerebroventricular (ivt) administration of a cholinergic agonist, oxotremorine, or antagonist, methylatropine. After three weeks treatment of young rats with ivt oxotremorine, the maximum number (Bmax) of 3H-QNB binding sites in frontal cortex, determined by saturation experiments, was reduced by 27%, with no apparent change in the affinity (Kd) of 3H-QNB for the muscarinic receptor. Conversely, chronic ivt methylatropine administered to 3 month old animals caused a 29% increase in Bmax with no significant change in Kd. Adult animals showed a somewhat lesser degree of muscarinic receptor plasticity (16% down-regulation after oxotremorine, 22% up-regulation after methylatropine). However, 3H-QNB binding parameters in frontal cortex from senescent rats were not significantly alterted following identical treatments with oxotremorine or methylatropine. Thus, muscarinic receptor adaptation to chronic, cholinergic drug administration was impaired in aged animals. This reduced receptor plasticity with aging could have important implications for the long-term drug treatment of elderly patients and for the therapeutic efficacy of cholinergic drugs in age-related neurological disorders, such as Alzheimer's disease.

Drug treatment in elderly patients: GP audit.

Drug treatment in elderly patients: GP audit.

Drug treatment in elderly patients: GP audit.

Drug treatment in elderly patients: GP audit.