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Therapeutics in older people 

Therapeutics in older people
Chapter:
Therapeutics in older people
Author(s):

Jackson Stephen

DOI:
10.1093/med/9780199689644.003.0005
Page of

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date: 23 October 2019

Key points

Pharmacokinetics in older people is different to that in younger people:

o renal clearance is lower (water-soluble drugs)

o hepatic clearance is lower (lipid-soluble drugs)

o half-life is further prolonged for lipid-soluble drugs because of the increased volume of distribution of such drugs

o in frail older patients, half-life is further prolonged

by reduced hepatic enzyme activity (lipid-soluble drugs)

by reduced protein binding and hence increasing the volume of distribution (very heavily protein-bound drug).

Polypharmacy is common and reflects multiple pathology.

Inappropriate medication should always be avoided.

Methods of enhancing the quality of prescribing include

o regular medication review

o prescribing audit using proven indicators of appropriateness

o education of prescribers.

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