Tuesday, July 21, 2009

Medicines and Drugs to Treat Elderly




Every type of machinery functions normally for some years but starts giving problems with age. This is true for a bicycle, a car, a railway engine, or an aeroplane. The body functions also, do not remain as efficient in old age as in youth or middle age. Besides physiological changes associated with ageing, other factors such as the multiple disease processes, nutritional deficiencies, inability to adhere to drug-schedules, and the decline of financial resources multiply problems in old age. Besides these, in those who are not aware, lack of proper physical exercise and the ability to modify the diet suitably are also responsible for causing undesirable responses to drugs. The doctor who treats the elderly has to be more knowledgeable, more careful. As individuals age, they are more likely to have disability and side effects of drugs. Before 1947, the average age of an Indian was 37 years, which has now increased to 67 years. This means that the percentage of older people in this country has increased considerably. In many ways, our situation is coming close to countries of the west where the average age is as high as 77 or 78 years. These countries have learnt to overcome the problems of old age, including those of altered drug response. This chapter discusses the mechanism of altered clinical responses of drugs in the elderly and outlines a preferable approach to therapeutic management with examples of disease entities. Altered Organ Functions Result in Changes in Drug Effects and DisposalAgeing affects many a physiological function of the body. The functional capacity of most the major organs like the kidneys, heart, liver and lungs shows a continuous decline after the age of 45. Besides this, the elderly have a reduced lean body mass (as % of body weight), reduced body water (as % of body weight), and increased body fat (as % of body mass). The impact of these changes, coupled with a progressive decline in functional capacities, results in an altered handling of the drug by the aged body in terms of its absorption, distribution, metabolism, and excretion.Metabolism of Drugs in the Elderly: The capacity of the liver to metabolise drugs does not appear to decline with age. Yet, certain extra hepatic diseases like congestive heart failure may dramatically reduce the ability of the liver to metabolise drugs. The cognitive effects of antiepileptic drugs (AEDs) is a controversial topic which is incompletely understood. Effects in the elderly are of particular interest as this group is particularly sensitive to these effects and relatively understudied. Many cognitive studies in patients with epilepsy are difficult to interpret, however, as variables such as seizure improvement may be the actual source of differences. This study has the advantage of using healthy volunteers and a crossover design, eliminating confounding factors of unrecognized seizures and polytherapy and limiting influences of interindividual variability. Doses were reasonable (target 800 mg carbamazepine and 2400 mg/day gabapentin), and treatment was long enough to overcome acute effects although relatively brief (six weeks). It should be remembered that AEDs could have different effects in epilepsy patients independent of seizures, perhaps due to influences on interictal discharges. Nevertheless, this represents a well designed, rigorous study utilizing a number of neuropsychological effects and a reasonable approximation of chronic therapy.--AdvCare is one of the Canada leading pharmacy website. First established in January 2000, its mission is to become the number one site for prescription drug and drug store searches.Source: http://www.articletrader.com
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