This episode of CRACKCast covers Rosen’s chapter 185, Drug Therapy in the Geriatric Patient. Although short, this post contains vital information that will help you optimize the care of yours elderly patients in the ED. Take some time to commit this information to memory, as it will no doubt help you on your next shift.
Shownotes – PDF HERE
Rosen’s In Perspective
- The elderly are coming in droves!
- Drug therapy issues are particularly challenging in older adults because of altered pharmacokinetics and pharmacodynamics compared to younger adults.
- In addition, they take more medications, have more comorbidities, and are at increased risk for adverse drug effects because of the physiologic changes of aging
- As a result, medication selection and dosing need to be age-adapted for optimal patient outcomes.
 List 4 factors altering pharmacokinetics in the elderly (ADME)
Please refer to Table 185.1 from Rosen’s 9th Edition for a more comprehensive summary of the factors altering pharmacokinetics in the elderly.
Pharmacokinetic Changes in Older Adults
 List 6 factors contributing to adverse events from medications in the elderly
- Polypharmacy / drug interactions
- All of the pharmacokinetic reasons:
- Altered GI motility and perfusion
- Decreased hepatic function
- Decreased renal function
- Decreased lean body mass
- Increased adipose tissue
- Changes in protein binding
 Which meds are most responsible for adverse events in the elderly?
REMEMBER: The Beers criteria are a consensus guideline published semi-regularly that provides clinicians with lists of medications that should be avoided in older adults.
Please refer to Table 185.3 from Rosen’s 9th Edition for a more comprehensive summary of the most common Beers List medications prescribed in the ED.
 List 9 harmful drug interactions in the elderly
Please refer to Table 185.2 from Rosen’s 9th Edition for a more comprehensive summary of harmful drug interactions in older patients
|Benzos and Sedative-Hypnotics||Fractures, Falls|
 What are the top 10 STOPP criteria?
REMEMBER: STOPP (Screening Tool of Older Persons’ Potentially Inappropriate Prescriptions) are newer criteria to identify potentially inappropriate medications in the elderly, including drug–drug and drug–disease interactions, drugs which increase risk the of falls, and drugs which duplicate therapy.
REMEMBER: Unlike the Beers List, the STOPP criteria have been significantly associated with avoidable adverse drug events in older people that cause or contribute to hospitalization.
Please refer to Table 185.4 from Rosen’s 9th Edition for a more comprehensive summary of the top ten STOPP criteria
- Long-term use of benzodiazepines
- Duplicate prescriptions from the same drug class
- Proton pump inhibitor for peptic ulcer disease at full dose for >8 weeks
- NSAID’s in patients with moderate to severe hypertension
- Long-term use of opioids
- Aspirin without adequate cardiovascular risk
- Warfarin and NSAID used together
- Beta blocker in patients with COPD
- Prolonged use of first-generation antihistamines
- NSAID use in patients with chronic renal failure
This post was formatted and copyedited by Dillan Radomske (@dillanradomske)