Drugs In Elderly Patients Research Articles

Patterns of prescription and inappropriate medications use in elderly patients of Makkah community in Saudi Arabia

Polypharmacy and the prescription of inappropriate medications are common in elderly patients due to the high rate of morbidity in this population. However, this information is scarce about patients in this age group in Saudi Arabia. In general, this study was conducted to investigate the drug prescriptions in elderly patients in Makkah city of Saudi Arabia. This topic threw light mainly on the pattern of drug utilization and the prevalence of potentially inappropriate medications in this population of patients. Data of drugs utilization in elderly patients was collected from King Abdul-Aziz hospital in Makkah city, Saudi Arabia during January and February of 2018. The 2019 updated Beers criteria were applied to identify the potentially inappropriate medications use in these patients. A total of 1256 prescriptions were found to be given to 129 elderly patients, with a 9.7 as the average number of drugs prescribed per elderly patient. Polypharmacy in this age group was very common reaching about 90% of patients. The most commonly prescribed drug was omeprazole followed by aspirin. Around 18% of drug prescriptions were considered to be inappropriate according to the 2019 updated Beers criteria. Omeprazole and aspirin were also the inappropriate drug with the highest rate of prescription. Based on the 2019 updated Beers criteria, inappropriate medications use and polypharmacy are prevalent in elderly patients in Makkah city of Saudi Arabia. More attention should be taken by health care providers as some of the commonly prescribed drugs in elderly patients are considered to be inappropriate. Key words: Potentially inappropriate medications, drug prescribing, polypharmacy, elderly, geriatrics, Beers.

Efficiency and tolerability of abemaciclib in elderly patients

Elderly cancer patients represent a very heterogeneous population not only in chronological age, but also in functional status, concomitant diseases and therapy, geriatric syndromes, and, as a consequence, in the tolerability of cancer treatment. The choice of treatment for metastatic breast cancer (mBC) in this category of patients is often a difficult task for oncologists. The emergence of a new class of drugs, inhibitors of cyclin-dependent kinases 4/6 (CDK4/6), has changed the paradigm of treatment of patients with luminal HER2 negative mBC (ER + HER2mBC); however, data on the efficacy and tolerability of these drugs in elderly patients are limited. Pooled subgroup analyzes of studies with CDK4/6 have shown that elderly patients with ER + HER2breast cancer have a clear PFS benefit from the addition of targeted drugs to hormonal therapy. Adverse events are observed more often in combination therapy with increasing age, which requires dose modification and appropriate therapy. In this regard, the drug abemaciclib is very attractive, which is characterized by a lower frequency of neutropenia compared to other CDK4/6 inhibitors, but a higher incidence of diarrhea, which can be controlled by taking appropriate drugs and is not a reason for treatment discontinuation. Careful selection of patients is necessary when deciding on the appointment of any therapy to geriatric cancer patients. Only a comprehensive multidisciplinary approach will make it possible to maximally individualize the approach to the treatment of this difficult category of patients and minimize the likelihood that they will receive excessive or insufficient oncological treatment.

Usage and adherence of antidementia drugs in a memory clinic cohort in Chongqing, Southwest China

AbstractBackgroundTo investigate the use and adherence of anti‐dementia drugs in elderly patients with dementia from the Memory Clinic of The First Affiliated Hospital of Chongqing Medical University.MethodPatients were recruited from the Memory Clinic of The First Affiliated Hospital of Chongqing Medical University between December 2010 and December 2018. The medical chart was reviewed, including diagnosis, dosage of antidementia medicine, neuropsychological testing scores, and the further questionnaires were conducted via face‐to‐face or telephone, included duration of treatment, types of anti‐dementia drugs, and reasons for treatment discontinuation.ResultThe data from 422 patients were analyzed retrospectively for this study. 315 were diagnosed with AD, 67 with MCI, and 40 with other types of dementia. From the 422 patients, 26.8% were treated with original donepezil, 11.6% with generic donepezil, 24.6% with memantine, 13.3% with huperzine A, and 23.7% with a combination of drugs. However, 73% of patients discontinued treatment within one year of initiation. Patients with less than nine years of education were more likely to discontinue treatment than patients with more than nine years of education. Patients with elevated PSMS scores had a high risk of discontinuation. Patients had a higher risk of discontinuation when they had received treatment for less than 36 months.ConclusionOverall treatment compliance is relatively poor in memory clinic in Chongqing. Our study demonstrates that high education, combined medication may lead to better treatment adherence in dementia care. However, poorer PSMS is a significant risk factor for treatment discontinuation.

The role of the State Drug Formulary of Ukraine in providing rational pharmacotherapy for elderly patients

Applying the Classification for Drug-Related Problems (DRPs) of the Pharmaceutical Care Network Europe (V 9.00, 2019) allowed to systematize the information on the use of drugs in elderly patients given in the Annex of the State Drug Formulary of Ukraine. As a result of this work, special warnings and recommendations of the State Drug Formulary were presented together with the possible causes for potential DRPs, which they allow to prevent. The lists of potentially inappropriate medications (PIMs) for the elderly (n = 98), drugs the dosage of which in patients of this age group should be adjusted (n = 127), and drugs that need monitoring (n = 108) were formed. The obtained results can serve as a basis for the development of a specialized geriatric tool to ensure rational pharmacotherapy, in particular in the provision of pharmaceutical care.

Trends in Initial Systemic Therapy for Elderly Patients with Metastatic Clear Cell Renal Cell Carcinoma.

BACKGROUND:The treatment landscape for metastatic clear cell renal cell carcinoma (mRCC) is rapidly changing. It is unknown how adoption of new types of therapies may differ by patient age.OBJECTIVE:To compare trends in first-line therapy use for older (≥70 years) and younger (< 70) patients with mRCC before and after approval of nivolumab in 2015.METHODS:Using the National Cancer Database, we assessed trends in first-line therapy use by calculating the proportion of patients receiving targeted therapy, immunotherapy, or no systemic therapy by year of diagnosis. Initial systemic treatment was compared for patients diagnosed in 2016 with patients diagnosed in 2011 as a control group prior to nivolumab approval. Multivariable regression analysis was used to evaluate the interaction between year of diagnosis and elderly status for use of first-line immunotherapy or targeted therapy.RESULTS:From 2006 to 2016, the proportion of patients receiving any type of systemic therapy increased from 43.7% to 56.5%. On stratified multivariable regression analysis, older patients diagnosed in 2016 were 17.3 times more likely to receive first-line immunotherapy compared to those diagnosed in 2011, while younger patients were 2.3 times more likely. There was no change in targeted therapy use over this time regardless of patient age.CONCLUSIONS:The rate of adoption of first-line immunotherapy was particularly pronounced for elderly compared to younger patients. While first-line use of immunotherapy may have allowed elderly patients to receive systemic therapy that they otherwise would not, the efficacy of these drugs in elderly patients deserves further study.

Atorvastatin promotes bone formation in aged apoE\u2013/\u2013 mice through the Sirt1\u2013Runx2 axis

BackgroundStatins are the most widely used drugs in elderly patients; the most common clinical application of statins is in aged hyperlipemia patients. There are few studies on the effects and mechanisms of statins on bone in elderly mice with hyperlipemia. The study is to examine the effects of atorvastatin on bone phenotypes and metabolism in aged apolipoprotein E-deficient (apoE–/–) mice, and the possible mechanisms involved in these changes.MethodsTwenty-four 60-week-old apoE–/– mice were randomly allocated to two groups. Twelve mice were orally gavaged with atorvastatin (10 mg/kg body weight/day) for 12 weeks; the others served as the control group. Bone mass and skeletal microarchitecture were determined using micro-CT. Bone metabolism was assessed by serum analyses, qRT-PCR, and Western blot. Bone marrow-derived mesenchymal stem cells (BMSCs) from apoE–/– mice were differentiated into osteoblasts and treated with atorvastatin and silent information regulator 1 (Sirt1) inhibitor EX-527.ResultsThe results showed that long-term administration of atorvastatin increases bone mass and improves bone microarchitecture in trabecular bone but not in cortical bone. Furthermore, the serum bone formation marker osteocalcin (OCN) was ameliorated by atorvastatin, whereas the bone resorption marker tartrate-resistant acid phosphatase 5b (Trap5b) did not appear obviously changes after the treatment of atorvastatin. The mRNA expression of Sirt1, runt-related transcription factor 2 (Runx2), alkaline phosphatase (ALP), and OCN in bone tissue were increased after atorvastatin administration. Western blot showed same trend in Sirt1 and Runx2. The in vitro study showed that when BMSCs from apoE–/– mice were pretreated with EX527, the higher expression of Runx2, ALP, and OCN activated by atorvastatin decreased significantly or showed no difference compared with the control. The protein expression of Runx2 showed same trend.ConclusionsAccordingly, the current study validates the hypothesis that atorvastatin can increase bone mass and promote osteogenesis in aged apoE−/− mice by regulating the Sirt1–Runx2 axis.

Relationship between Potentially Inappropriate Anticholinergic Drugs (PIADs) and Adverse Outcomes among Elderly Patients in Taiwan

The Beers' criteria indicate that some anticholinergic drugs are inappropriate for treating elderly patients, but those most frequently used anticholinergic drugs in previous studies. This study was aimed to explore the association between the potentially inappropriate anticholinergic drugs (PIADs) and adverse outcomes among elderly people in Taiwan. A retrospective cohort study was conducted by analyzing the Longitudinal Health Insurance Database (LHID2005) of the National Health Insurance Research Database (NHIRD) from 2007 to 2008 to investigate all prescriptions for elderly people above the age of 65. The anticholinergic risk scale (ARS) constituted the criteria for PIADs. Adverse outcomes included emergency visits, hospitalization, and adverse drug reactions (ADRs) such as constipation, delirium, cardiac arrhythmia, and cognitive impairment. The prevalence of PIADs was 18.67% in outpatient prescriptions. Approximately 75.65% of outpatients have received at least one PIAD. After adjusting for age, gender, the number of drug items, and CCI, patients, who have received PIADs, had higher risks of emergency visits, hospitalization, constipation, delirium, and cardiac dysrhythmia (odds ratio [OR] = 1.85, 1.07, 1.87, 1.51 and 1.16) than those who have never received PIADs. This study suggests that physicians should be cautious when prescribing anticholinergic drugs for elderly patients to reduce the risk of adverse outcomes and improve the safety of medicating elderly people.

The Prescribing Patterns of Antipsychotic Drugs and Antiparkinsonian Drugs in Elderly Patients with Dementia

The Prescribing Patterns of Antipsychotic Drugs and Antiparkinsonian Drugs in Elderly Patients with Dementia

Usage and adherence of antidementia drugs in a memory clinic cohort in Chongqing, Southwest China.

To investigate the use and adherence of antidementia drugs in elderly patients with dementia from the Memory Clinic of The First Affiliated Hospital of Chongqing Medical University. Patients were recruited from the Memory Clinic of The First Affiliated Hospital of Chongqing Medical University from December 2010 to December 2018. Medical charts were reviewed, including diagnosis, dosage of antidementia medicines, neuropsychological testing scores, and the further questionnaires were conducted via face-to-face or telephone, included duration of treatment, types of antidementia drugs, and reasons for treatment discontinuation. The data from 422 patients were analysed retrospectively for this study. Three hundred and fifteen were diagnosed with Alzheimer's disease (AD), 67 with mild cognitive impairment (MCI), and 40 with other types of dementia. From the 422 patients, 26.8% were treated with original donepezil (n = 113), 11.6% with generic donepezil (n = 49), 24.6% with memantine (n = 104), 13.3% with huperzine A (n = 56), and 23.7% with a combination of drugs (n = 100). However, 73% of patients discontinued treatment within 1 year of initiation. Patients treated for more than 36 months (37.8%) were more likely to choose combined medication, as compared with patients treated for less than 36 months. Patients with less than 9 years of education (odds ratio (OR): 2.394; 95% CI: 1.508-3.801) were more likely to discontinue treatment than patients with more than 9 years of education. Patients with elevated physical self-maintenance scale (PSMS) scores (OR: 1.195; 95% CI: 1.086-1.316) had a high risk of discontinuation. Overall treatment compliance is relatively poor in memory clinics in Chongqing. Our study demonstrates that higher education may lead to better treatment adherence in dementia care. Combination therapy may increase treatment time. However, poorer PSMS scores are a significant risk factor for treatment discontinuation.

Effectiveness and safety of biologic and targeted synthetic disease-modifying anti-rheumatic drugs in elderly patients with rheumatoid arthritis: real-world data from the KOBIO Registry

We aimed to evaluate the clinical outcomes and safety of biologic and targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs) and to identify predictors of treatment responses to b/tsDMARDs in elderly patients with rheumatoid arthritis (RA). Data from the nationwide cohort of elderly (≥ 65 years) patients enrolled in the KOBIO Registry were analysed. Clinical outcomes were assessed, including changes in the Simplified Disease Activity Index, after treatment. Adverse events and reasons for drug discontinuation were assessed. Multivariable logistic regression analyses were performed to determine which baseline variables affected treatment responses and adverse events (AE). Elderly patients treated with b/tsDMARDs (n=355) or conventional synthetic DMARDs (csDMARDs) (n=104) were included. The median age was 70 years and 77% were female. After 1 year, 63% of patients in the b/tsDMARD group and 68% in the csDMARD group achieved remission or low disease activity (LDA). Overall, 27% of patients in the b/tsDMARDs group and 24% in the csDMARDs group experienced AE. A total of 43.4% of patients on b/tsDMARDs discontinued therapy due to lack of effectiveness (27%), AE (34%), or other reasons (35%). The estimated median retention of b/tsDMARDs was 2.5 years. Male sex and non-exposure to tobacco at baseline were independent factors associated with achieving remission or LDA after 1 year. Interstitial lung disease (ILD) was the most prominent comorbidity associated with AE. Treatment with b/tsDMARDs is effective and well tolerated in elderly patients with RA; nonetheless, ILD is a key comorbidity that should be monitored carefully.

Deprescribing Antihypertensive Drugs in Patients of Older Age Groups

Arterial hypertension (AH) is one of the most common diseases in the elderly. It has been proven that lowering blood pressure (BP) is effective in preventing stroke and cardiovascular complications in patients even at the age of ≥80 years. On the other hand, there is evidence that a significant decrease in BP can be harmful to older people and may lead to a higher risk of overall mortality. Therefore, existing guidelines for the treatment of AH determine specific approaches for managing patients of older age groups, where the target BP levels are determined not only by age and concomitant diseases, but also by the presence of frailty. Moreover, there is a need to monitor the dynamics of frailty indicators (social, functional, cognitive and mental status of the patient), since their deterioration may require changes in the tactics of antihypertensive therapy (dose reduction, drug withdrawal or replacement) and changes in target BP levels. In this regard, in recent years, the possibility/necessity of a planned and controlled process of dose reduction, drug withdrawal or replacement, if this drug can be harmful and/or does not bring benefits (deprescribing), has attracted attention. This article is a review of current literature, which presents the design and main characteristics of randomized clinical trials (RCTs) and systematic reviews on the deprescribing of antihypertensive drugs in elderly patients with AH and frailty. An analysis of these studies showed the benefits of deprescribing of antihypertensive drugs for elderly patients with frailty, which avoids potential harm to their health, improves the quality of life and reduces the economic cost of treatment. Therefore, deprescribing of antihypertensive drugs can be used as an additional tool to achieve the necessary target BP values in patients of an older age group. However, for the development of deprescribing of antihypertensive drugs schemes and its introduction into clinical practice, the results of large specially planned RCTs are needed to study this issue.

Type 2 diabetes mellitus in elderly patients treated with endocrinologists in clinical practice

A large-scale epidemic of type 2 diabetes mellitus (T2DM) is observed with advanced ageing worldwide. The prevalence of T2DM significantly increases with age. Therefore, this review aimed to summarise the data on T2DM in advanced and older aged patients. The primary geriatric syndromes, which should be considered for the management of older patients (cognitive impairment, sarcopenia, orthostatic hypotension, falls, urinary incontinence, senile asthenia, etc.), are presented. The causes of the high risk for hypoglycaemia in elderly patients are analysed. Improving the treatment for T2DM is a priority of modern medicine. Using antihyperglycaemic therapy is especially difficult in this population due to the high risk of hypoglycaemia and the multi-organ pathology leading to polypharmacy. Therefore, special attention is paid to treatment recommendations. Hypoglycaemic drugs used in elderly patients should be low risk of hypoglycaemia, without nephro- and hepatic toxicity, safe for cardiovascular organs, easy to administer. Furthermore, advantages and limitations of using various groups of hypoglycaemic drugs in elderly patients are discussed. DPP-4 inhibitors are also considered in detail. Modern data on mechanisms of hypoglycaemic action of DPP-4 inhibitors are presented. Possibilities of using sitagliptin in elderly patients were also considered. Finally, evidence-based studies demonstrating the obvious advantages of sitagliptin for the treatment of T2DM in the elderly and advanced aged population are discussed.

Comparing healthcare cost associated with the use of enzyme-inducing and non-enzyme active antiepileptic drugs in elderly patients with epilepsy in the UK: a long-term retrospective, matched cohort study

BackgroundIn elderly patients (≥65 years of age) with epilepsy who take medications for comorbid conditions, some antiepileptic drugs (AEDs) may alter the metabolism of other treatments and increase the risk of adverse consequences and healthcare utilisation. This analysis compares healthcare costs associated with enzyme-inducing AEDs (EIAEDs) and non-enzyme active AEDs (nEAAEDs) use in elderly patients with epilepsy.MethodsThis retrospective matched cohort study used the Clinical Practice Research Datalink (CPRD) of UK primary care medical records, linked to the Hospital Episode Statistics (HES) database. Selected patients with epilepsy were ≥ 65 years and prescribed an EIAED or nEAAED between 2001 and 2010 (index) after ≥1 year without AEDs (baseline) and followed until the first occurrence of the following: end of HES data coverage, end of GP registration, or death; practice’s up-to-standard status or addition of an AED belonging to another cohort or discontinuation of the last AED of that cohort. Propensity score matching reduced confounding factor effects between cohorts. Key outcomes included time to cohort treatment failure, time to index AED treatment failure, and direct healthcare costs in 2014 Pound Sterling (£) values.ResultsOverall, 1425 elderly patients were included: 964 with EIAEDs and 461 with nEAAEDs. At baseline, the EIAED cohort was older (mean age, 76.2 vs. 75.1 years) and a higher proportion were male. Baseline direct healthcare costs were similar. After matching (n = 210 each), and over the entire follow-up period, median monthly direct healthcare costs were higher for patients taking EIAEDs than nEAAEDs (£403 vs. £317; p = 0.0150, Mann-Whitney U). Costs were higher for patients remaining in the EIAED cohort after 3 follow-up years. The median time to cohort treatment failure for the EIAED cohort was 1110 days vs. 1175 days for the nEAAED cohort.ConclusionNewly treated elderly patients with epilepsy were more likely to be prescribed EIAEDs than nEAAEDs. In matched cohorts, elderly patients with epilepsy treated with EIAEDs had higher average total direct and epilepsy-related healthcare costs than nEAAED-treated patients; this difference was greater than previously reported in the overall adult population. Changing treatment practices could improve patient care and reduce costs.

Study on prescribing pattern and rational use of antidiabetic drugs in elderly patients with type 2 diabetes mellitus in tertiary care hospital

Background: Type 2 diabetes mellitus (DM) is one of the most common diseases in the elderly. Due to the presence of comorbid conditions, geriatric patients are usually on more than 1 drug and hence this vulnerable population requires frequent monitoring. Drug utilization studies could provide feedback to prescribers and promote rational drug use. Aims and Objectives: This study aims to analyze the drug prescribing pattern and rational use of antidiabetic drugs in geriatric age group with type 2 DMs. Materials and Methods: A prospective, cross-sectional, observational study was conducted from January 2017 to June 2018 in the geriatric Medicine Department at JSS Medical College and Hospital, Mysuru. Prescriptions were collected from geriatric diabetic patients and were analyzed for prescribing pattern and rational use of antidiabetic drugs. The data were subjected to suitable descriptive and inferential statistical analysis, using Microsoft Excel and SPSS Version 23.0. Results: Out of 500 prescriptions analyzed, 706 antidiabetic drugs were prescribed, 90% were oral, 8.31% were injectable, and 1.69% were received both routes. Average number of antidiabetic drugs prescribed per prescription was 0.7. The most commonly prescribed oral hypoglycemic drug was metformin (66%), which was in combination with other antidiabetic drugs and alone. Drugs prescribed by generic name accounted for 18.9% and drugs from essential drug list were 41.78%. Conclusion: The study showed that metformin was predominantly prescribed oral antidiabetic drug both as monotherapy and combination therapy. Prescribing drugs by brand name were high and from essential drug list were low. Number of drugs prescribed per prescription was decreased which is a welcome sign and needs to be encouraged.

老年患者抗胆碱能药物使用情况横断面研究

老年患者抗胆碱能药物使用情况横断面研究

Prescription patterns of antihyperglycemic drugs in elderly patients in Spain: A national cross-sectional study

Background and objectiveElderly patients with type 2 diabetes represent a growing and heterogeneous group of subjects where treatment targets and antihyperglycemic drugs prescriptions should be tailored according to coexisting illnesses, functional and social domains. MethodsWe carried-out a national cross-sectional study (from February 2014 to December 2014) to assess prescription patterns and treatment inadequacy in patients with type 2 diabetes older than 65 years with at least 6 months of treatment with antihyperglycemic drugs. ResultsWe included a total of 4917 patients cared by 2100 family physicians and 450 specialists. Diabetes prescriptions were monotherapy (21.2%), dual therapy (58.1%) and triple therapy (20.6%). The most common prescription patterns were metformin in monotherapy (66.5%), metformin plus DPP4 inhibitors in dual therapy (77.3%) and, in triple therapy, oral drugs (45.5%) and oral drugs plus insulin (45.8%). A total of 1272 (25.9%) patients were at risk of serious hypoglycemia, 643 of them due to treatment with secretagogues (25%) or treatment with human insulin types (25.6%). ConclusionsElderly patients with type 2 diabetes often receive antihyperglycemic therapy with higher risk of hypoglycemia. Substitution of secretagogues and human insulin therapy for safer medication could significantly reduce the adverse effects of diabetes treatment in this population.

Analysis of prophylactic effect of extended-duration anticoagulant drugs in elderly patients undergoing hip fracture

To evaluate the prophylactic effect of extended-duration anticoagulant drugs on venous thromboembolism, and to explore the time of drug prevention for venous thromboembolism after hip fracture. A retrospective analysis of 143 patients undergoing hip fractures from November 2017 to October 2018 in Peking University People's Hospital was conducted to investigate the relationship between the extended-duration anticoagulant drug and the morbidity of venous thromboembolism and bleeding during the treatment. All the drug prevention programs for the patients included in the study were implemented in accordance with the 2016 edition of the Guidelines for Prevention of Venous Thrombosis in Orthopaedic Surgery by Orthopaedic Society of Chinese Medical Association. The patients in the two groups were followed up for venous thromboembolism and bleeding during the medication within 5 weeks after the fracture. Venous thromboembolism included symptomatic and asymptomatic deep venous thrombosis of the lower extremities, pulmonary thromboembolism, and all the patients with deep venous thrombosis of the lower extremities required vascular ultrasound results to obtain clear evidence. The results of vascular ultrasound were the basis for determining deep venous thrombosis. Bleeding conditions were included, but not limited to gastrointestinal bleeding, wound bleeding, intracranial hemorrhage, intraspinal hematoma, and fundus hemorrhage. There were no pulmonary thromboembolism in both groups after surgery. The morbidity of deep venous thrombosis was 22.09% and 8.77% in the 2-week and 4-week groups (P=0.037), the time to deep venous thrombosis in the two groups was (17.32±7.75) days and (29.20±0.17) days after surgery. One case of bleeding occurred during the use of anticoagulant drugs in both groups, the morbidity of bleeding during the treatment was 1.16% and 1.75% (P=0.769), respectively. Extended-duration anticoagulant drugs to 4 weeks after surgery can significantly reduce the morbidity of postoperative venous thromboembolism, and does not increase the risk of bleeding. Patients with a risk of bleeding should carefully assess the risks and benefits of drug prevention and choose the best treatment.

Characteristics of inappropriate multiple medication use in older urological outpatients

ObjectivesTo investigate polypharmacy and potentially inappropriate medications (PIMs) in elderly patients visiting the urology department for lower urinary tract symptoms (LUTS). MethodsWe retrospectively analyzed digital medical records of individuals over the age of 65 who visited the urology department for LUTS. This cross-sectional study was conducted in 10 hospitals located in South Korea, between September 2017 and December 2017. All prescribed medications were analyzed using electronic medical records. The updated 2015 Beers criteria were used to identify and assess the appropriateness of the prescribed drugs in elderly patients. ResultsWe analyzed a total of 2143 patients aged over 65 years from 10 institutions. The mean age was 74.2 ± 6.26 years (65–97), 1634 (76.2%) were men. Patients took a mean of 6.48 ± 2.46 medications (range 0–18), and polypharmacy was found in 1762 patients (82.2%). The number of patients who received PIMs at least once was 1579 (73.7%). The average number of PIMs used per patient was 1.31 ± 1.25 (0–7). PIM use ratio was 18.9 ± 0.15% (0–67%). The number of chronic diseases, and concurrent medication and polypharmacy were predictive factors associated with PIM use. ConclusionOur multi-institutional results show that a substantial proportion of elderly patients took PIMs when visiting the urology department. Factors associated with PIMs were the number of chronic diseases and polypharmacy. Medication use in elderly patients, especially in urology, should be monitored carefully.

A Review on Drug-drug Interaction Studies of Spiranolactone and Telmisartan

A drug interaction is a change in the action or side effects of a drug caused by concomitant Administration with a food, beverage, supplement, or another drug. There are many causes of drug interactions. For example, one drug may alter the pharmacokinetics of another. Alternatively, drug interactions may result from competition for a single receptor or signalling pathway. The risk of a drug-drug interaction increases with the number of drugs used. Over a third (36%) of the elderly in the U.S. regularly use five or more medications or supplements, and 15% are at potential risk of a significant drug-drug interaction. Drug interactions can have desired, reduced or unwanted effects. The probability of interactions increases with the number of drugs taken. The high rate of prescribed drugs in elderly patients (65-year-old patients take an average of 5 drugs) increases the likelihood of drug interactions and thus the risk that drugs themselves can be the cause of hospitalization. There are many causes of drug interactions. For example, one drug may alter the pharmacokinetics, absorption, distribution, metabolism, or excretion (ADME) of another. The risk of a drug interaction occurring increases as the number of drugs administered to a patient increases. Similarly the drug interaction studies of spiranolactone which is a potassium-sparing diuretics and telmisartan which is an angiotensin receptor blockers is known in this. And the qualitative and quantitative analysis of the two drugs is also studied in this.

Fragmentation studies of selected drugs utilized in palliative care.

The results of research on selected drugs used in palliative care are presented, including fentanyl, tramadol, metoclopramide, hyoscine butylbromide, midazolam, haloperidol, levomepromazine and clonazepam. Interpretation of their ESI mass spectra obtained by the use of a triple quadrupole linear ion trap mass spectrometer is given. As a result, fragmentation pathways described in the literature are complemented and presented with more details. On their basis, transitions for quantitative analysis are selected and chromatographic conditions for the determination of the palliative care drugs are proposed as well. These results enable future studies on palliative care drugs in elderly patients including both their quantitation in body fluids and easier identification of their metabolites.