Drug which caused the admission
FANS (29.6%)
Diuretics (27.3%)
Warfarin (10.5%)
Deaths caused by ADRs
ADRs/tot
28/1,225=2.2%
Deaths caused by:
FANS 67.8%
Warfarin+FANS 10.7%
More than 2/3 of adverse reactions to drugs are FORESEEABLE and AVOIDABLE
(Ger and Soc, 2002 – BMJ, 2004 – Pharmacotherapy, 2006).
Physiologcal changes in elderly people
(Mangoni AA, Jackson SH – Age-Related Changes in Pharmacokinetics:
Basic Principals & Practical Applications. Br J Clin Pharmacol, 2004)
Reduced gastric motility
Reduced secretion of acid/enzymes
Change in numbers of hepatocytes
Reduced production of albumen
Reduced number of functioning glomeruli
Reduced blood flow
Alterations in neurochemical transmission
Reduced cognitive capacity and ability
Physiological alterations in elderly people: what to do
Consider…
…the use of well-known drugs about which enough is known regarding the risk/benefit balance for elderly patients.
…the presence of organ insufficiencies.
…recourse to non pharmacuetical treatments (diet advice, smoking cessation, physical activity).
Some medicines are absoutely to be avoided…
Flurazepam (Dalmadorm ) and Diazepam (Valium ): prolonged sedation and higher rates of falls and femoral fractures.
Ketoralac (Toradol , Lixidol ): risk of gastrointestinal bleeding even in the short term.
Ticlopidina (Tiklid ): risk of neutropenia.
Naprossene and Piroxicam : risk of gastrointestinal bleeding, renal insufficiency and hypertension if used oved the long term.
Gastrointestinal disturbances
Constipation
Avoid: anticolinergics, antidepressants tricyclics
Ulcers
Avoid: FANS, aspirin, K+ integrators
Endocrine Disturbances
Diabetes
Avoid: corticosteroids, -blockers

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