Medication for the elderly


(1) Pharmacodynamic changes in the elderly The size of the drug effect after entering the body is not only related to the dose of drugs used, blood drug concentration, etc., but also has a great relationship with the sensitivity of the body tissues and organs to drugs.Due to the changes in the function of tissues and organs in the elderly, as well as the changes in the number of receptors and the affinity between drugs and receptors, the response to drugs also changes accordingly.1, the elderly to change the responsiveness of drugs target organs to increase the sensitivity of some drugs, can improve the efficacy.Decreased reactivity to a few drugs, that is, the sensitivity of target organs to drugs is reduced, such as the elderly body of B receptor agonist and B receptor antagonist reaction is significantly reduced, so the elderly use of propranolol to slow the heart rate is weakened.The changes of pharmacodynamics involve the number of drug receptors, the affinity of target cells, the information transmission mechanism, the decrease of cell response and the stability of internal environment, etc.2, the elderly medication individual difference of the elderly medication individual difference is incomparable to any other age group.The reasons for the large individual differences are as follows :(1) genetic factors and aging process are very different (2) aging changes of various tissues and organs are different (3) diseases suffered in the past and their effects are different (4) interactions of most diseases and most drugs combined (5) environment and psychological quality.Many scholars have always believed that adverse drug reactions increase with age, and are most common in the elderly over 75 years old.Other factors that increase the risk of adverse events in older patients include:(1) the past history of adverse drug reactions (2) (3) for a variety of conditions and use a variety of drugs kidney and liver dysfunction (4) the disease is not typical, clinical evaluation is inappropriate (5) in patients with medication adherence is poor, elimination of drug in your body changes may fall in the performance of adverse drug reactions, insanity, and unresponsive acute urinary incontinence or attack.Drugs that are likely to cause adverse reactions include drugs that affect mental behavior, antihypertensives, oral hypoglycemics, diuretics, digoxin, antibacterial drugs and arrhythmic drugs.(2) Changes in pharmacokinetics in the Elderly Quite a few drugs are more likely to cause adverse reactions in the elderly than in the young, and most of the adverse reactions are caused by pharmacodynamics, except for a few drugs.Therefore, when giving medication to the elderly, it is necessary to understand the pharmacokinetic characteristics of the elderly, so that rational medication can be used to avoid adverse reactions.1. Absorption 2. Distribution The factors affecting the distribution of drugs in vivo include blood flow, composition of the body, pH of body fluids, the combination of drugs with plasma proteins, and the combination of drugs with tissues.(1) Changes in body composition (2) Plasma protein content (3) Metabolism Most drug metabolism is metabolized by liver microsomal drug metabolism enzymes (drug enzymes), only a few drugs are metabolized by non-microsomal enzymes.4, excretion of most of the drugs and their metabolites through the kidney excretion, with the growth of age, kidney blood flow is reduced, glomerular rate is reduced, the active secretion function of renal tubules is reduced, so that the elderly drug excretion ability decreases.Even in the absence of kidney disease, the excretion of drugs mainly excreted by the kidney decreases with age, which is one of the main reasons for drug accumulation poisoning in elderly patients.(3) The general principle of medication for the elderly: emphasize individual treatment.1. Selection of drugs In the elderly after clear diagnosis of the disease, incompatibility should not exceed 3 to 4 kinds of drugs, because too many similar drugs or drugs with similar side effects and their application will aggravate adverse reactions;Some drugs may have serious or rare side effects on the elderly, so it is necessary to carefully use or closely observe the occurrence of adverse reactions while using, so as to stop the drug in time.2, the choice of dose the elderly generally use adults 1/2~2/3 or 3/4 of the dose, it is best to individuate the dose, which is particularly important to the drug mainly excreted by kidney and the treatment index is small.3, the choice of treatment should try to simplify the treatment plan, so that elderly patients easy to understand and accept.In addition, pay attention to the supplement of food nutrition;Diabetes control diet;Limit potassium-rich foods when using diuretics;The use of cardioside and antihypertensive drugs should limit salt in food;Supplement B vitamins to drinking elderly patients.

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