Pharmacologic Issues in Geriatric Emergency Medicine
| Autor: | Michelle Blanda |
|---|---|
| Rok vydání: | 2006 |
| Předmět: |
Geriatrics
Drug Polypharmacy medicine.medical_specialty Health Services for the Aged business.industry media_common.quotation_subject medicine.disease Drug Prescriptions United States Quality of life (healthcare) Pharmaceutical Services Intensive care Emergency medicine Emergency Medicine medicine Humans Intensive care medicine business Adverse effect Geriatric pharmacology Adverse drug reaction Aged media_common |
| Zdroj: | Emergency Medicine Clinics of North America. 24:449-465 |
| ISSN: | 0733-8627 |
| DOI: | 10.1016/j.emc.2006.01.007 |
| Popis: | The geriatric emergency care model emphasizes older emergency patients be considered a special population, analogous to pediatric patients [1]. This concept is especially relevant to pharmacologic issues in the elderly. The need for practitioners to create a balance between using medications with adverse effects while providing access to therapies that may have a beneficial effect on morbidity, mortality, function, and quality of life is challenging. Variables affecting this challenge in the elderly population include comorbidities, limited evidence for efficacy, increased risk of adverse drug reactions, polypharmacy, and altered pharmokinetics. Elderly patients become involved in a vicious cycle described by Rochan as the ‘‘prescribing cascade’’ [2,3]. This cascade begins when an adverse drug reaction is misinterpreted as a new medical condition. A drug is prescribed to treat this new ‘‘medical condition’’ and another adverse drug effect occurs. Again, this is interpreted as a new condition and the patient is again subjected to unnecessary treatment and additional adverse effects of the drug. Because elderly patients have multiple medical problems they are prescribed multiple medications that lead to increased risk of adverse effects. Many of these adverse effects go unrecognized as such and lead to new drugs being added. This perpetuates the continued cycle of adverse effects. This article describes the scope of the problem of drug prescribing in the elderly. It looks at the concept of adverse drug reactions and events, principles underlying clinical geriatric pharmacology, and reviews drugs that commonly cause adverse drug reactions. It includes recommendations about drugs to be avoided and substitutes and approaches to evaluate the evidence for risk and benefits when selecting drugs for an elderly person. |
| Databáze: | OpenAIRE |
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