Prescribing for Elderly Patients (eBook)

Stephen Jackson, Paul Jansen, Arduino Mangoni (Herausgeber)

eBook Download: PDF

2009
John Wiley & Sons (Verlag)
978-0-470-02429-4 (ISBN)

Infos

• A guide for doctors to quickly choose the right drugs in the right dose for the most important clinical problems in the elderly
• Prescribing medications for elderly patients is complex - this book gives clear advice on treatment regimes, drug interactions, adverse effects, and recommended dose changes
• Provides practical help with the problems that can arise in reaching an accurate diagnosis in the elderly, recommends clear treatment options, lists key drug interactions and side effects, and advises when to amend doses

Professor Stephen Jackson, Professor of Geriatric Medicine, King's College London, UK.

Dr Paul Jansen, Department of Geriatric Medicine, University Medical Centre Utrecht, The Netherlands.

Dr Arduino Mangoni, Senior Lecturer and Consultant Physician in Clinical Pharmacology, Flinders University, Adelaide, Australia.

Inhalt

Prescribing for Elderly Patients 3
Contents 9
List of Contributors 21
Foreword 25
Preface 27
Acknowledgement 29
1 Clinical Pharmacology of Ageing 31
Epidemiology 31
Age-related changes in pharmacokinetics 32
Age-related changes in pharmacodynamics 33
Adverse drug reactions and drug interactions 34
Adherence 36
Polypharmacy versus appropriate prescribing 37
Over-the-counter medicines 37
Prescribing audit 38
Medication review 39
Undertreatment 39
References 40
2 Dementia, Delirium, Agitation and Behavioural Problems 43
Dementia 43
Delirium 48
Agitation and behavioural problems 52
References 55
3 Depression in Elderly Patients 57
Introduction 57
Aetiology 57
Signs and symptoms 58
Diagnosis 59
Therapy 60
References 63
4 Psychotic Illness in Elderly Patients 65
Introduction 65
Aetiology 65
Symptoms and signs 67
Diagnosis 68
Therapy 68
Key points 70
References 73
5 Sleep Disorders in the Elderly: the Pros and Cons of Prescribing 75
Insomnia 75
Restless legs syndrome and periodic limb movements of sleep 78
Nocturnal leg cramps 80
REM behaviour disorder 80
References 81
6 Stroke 83
Introduction 83
Aetiology 83
Modifiable risk factors for stroke 83
Therapy 84
Key points 91
References 91
7 Orthostatic Hypotension, Postprandial Hypotension and Syncope in Older Patients 93
Orthostatic hypotension in older patients 93
Key points 96
Postprandial hypotension in older patients 96
Key points 98
Syncope in older patients 99
Key points 101
Guidelines 101
References 101
8 Parkinson’s Disease 103
Introduction 103
Symptoms and signs of PD 104
Aetiology and pathology 105
Diagnosis 105
Therapy 106
Key points 111
Links 111
References 111
9 Epilepsy 113
Introduction 113
Aetiology 113
Symptoms and signs 113
Diagnosis 114
Therapy 115
Newer anti-epileptic drugs 115
Safety of anti-epileptic drugs 116
Therapy scheme of the advised drugs 117
Clinically-important drug interactions within anti-epileptic drugs 117
Clinically-important drug interactions with other drugs 117
Important adverse effects 117
Drug withdrawal 117
Key points 120
References 120
10 Hypertension 121
Introduction 121
Aetiology 121
Symptoms and signs 122
Diagnosis 122
Investigation 123
Therapy 123
Clinical pharmacology of antihypertensive therapy 124
Key points 129
Links 129
References 129
11 Lipid-Lowering in the Elderly Patient 131
Introduction 131
Aetiology 131
Symptoms and signs 132
Diagnosis 132
Therapy 133
Statins 133
Fibrates 136
Nicotinic acid 136
Ezetimibe 137
Bile acid sequestrants 138
Omega-3 fatty acids 138
Guidelines 138
Key points 139
Links 139
References 139
12 Acute Coronary Syndrome 141
Introduction 141
Aetiology 141
Symptoms and signs 142
Diagnosis 142
Therapy 144
Therapy scheme of the advised drugs 147
Key points 147
Guidelines 147
Acknowledgements 147
References 153
13 Heart Failure 155
Introduction 155
Epidemiology 155
Aetiology 155
Clinical presentation 157
Diagnosis 157
Therapy 158
Key points 167
Guidelines 167
Acknowledgements 167
References 167
14 Atrial Fibrillation and Other Rhythm Disturbances in the Elderly 169
Introduction 169
Atrial arrhythmias 169
The epidemiology and cost of AF 169
The mechanism of atrial tachyarrhythmias 170
Symptoms and signs 170
Diagnosis 170
Classification of AF 172
Causes of AF 172
Principles of management of AF 172
Treatment of acute onset AF 173
Suppression of paroxysms of AF 173
Strategies in persistent AF—rate versus rhythm control 175
Rate control in permanent AF 176
Risk of stroke and antithrombotic therapy in AF 178
Non-pharmacological techniques to prevent thrombus formation 180
Key points 180
References 180
15 Valvular Heart Disease 181
Introduction 181
Infective endocarditis 181
Prevention of endocarditis 182
Diagnosis and treatment of endocarditis 182
Prevention of thromboembolism 185
Prevention of progression of degenerative valvular disease 188
References 189
16 Anticoagulants for Thrombosis and Embolism in the Elderly 191
Introduction 191
The anticoagulants 191
Thrombosis in the elderly and indications for anticoagulants 192
References 198
17 Haematological Disorders 201
Introduction 201
Anaemia 201
Vitamin B12 and folic acid deficiencies 203
Thrombocytopenia 203
Myelodysplastic syndromes 205
Acute leukaemia 206
Lymphoproliferative conditions 207
Multiple myeloma 210
Key points 210
References 210
18 COPD and Asthma in the Elderly 213
Risk factors and triggers 213
Presentation and diagnosis 214
Objective tests 214
Differential diagnoses 216
Management of COPD and asthma 216
Acute asthma 222
Management of exacerbations of COPD 222
Management of stable COPD 225
Conclusion 225
Key Points 226
Learning Resources 226
Guidelines 226
References 227
19 Pneumonia in the Elderly 229
Introduction 229
Epidemiology 229
Aetiology and pathogenesis 229
Symptoms and signs 230
Diagnosis 230
Patient assessment 231
Therapy 232
Important considerations for drug usage 233
Prevention 236
References 236
20 Therapeutic Aspects of Pulmonary Tuberculosis 241
Introduction 241
Pathogenesis 241
Presentation of tuberculosis in the elderly 242
Diagnosis of tuberculosis 243
Treatment of tuberculosis 243
Treatment of latent tuberculosis infection 251
Key points 252
References 252
21 Interstitial Lung Disease in the Elderly 255
Introduction 255
Presentation of interstitial lung disease 255
Particular problems in the elderly 257
General comments with regard to therapy 259
Assessing the response to therapy 259
Drugs used in ILD 259
Treatment for specific forms of lung disease 260
Key points 264
Links 264
References 264
22 Lung Cancer in the Elderly 267
Introduction 267
Aetiology 267
Symptoms and signs 268
Diagnosis and staging 268
Goals of therapy 269
Chemotherapeutic agents 269
Treatment protocols for NSCLC 270
Non cytotoxic agents: EGFR Inhibitors 272
Treatment of small cell carcinoma 274
Treatment of mesothelioma 274
Anti-emetic therapy 275
Key Points 275
Guidelines 276
References 276
23 Nutritional Disorders and the Older Person 279
Introduction 279
Obesity and the older person 279
Nutritional frailty 282
Under-nutrition in older people 282
Screening and assessment of under-nutrition 284
The management of the under-nourished older person 287
Monitoring and change 289
Conclusion 289
References 289
24 Mouth and Dental Disorders 293
Introduction 293
Periodontal disease 293
Dental caries 294
Odontogenic infections 295
Alveolar osteitis 296
Xerostomia and hyposalivation 296
Candidiasis 297
Angular cheilitis 298
Denture stomatitis 298
Burning mouth syndrome 299
Recurrent aphthous stomatitis 300
Recurrent herpes simplex 301
Oral lichen planus 302
25 Swallowing Disorders and Medication in the Elderly 305
Introduction 305
Normal deglutition 305
Changes with Age 306
Aetiology of deglutition disorders 307
Symptoms and signs 307
Diagnosis 307
Therapy 307
Deglutition disorders and medication 308
Key points 311
Links 311
References 311
26 Upper Gastrointestinal Disorders 313
Gastrooesophageal reflux disease 313
Oesophageal motility disorders 316
Non-cardiac chest pain 317
Oesophageal infections 317
Pill-induced oesophagitis 317
Peptic ulcer disease 318
Gastritis 322
Non-ulcer dyspepsia 322
References 323
27 Gastric Emptying in Older Patients 325
Introduction 325
Aetiology of disturbed gastric motor function in ageing 326
Symptoms and signs 326
Diagnosis 327
Therapy 327
Therapy scheme of advised drugs for gastroparesis 327
Key points 327
Guidelines 328
Effect of healthy ageing on appetite regulation—anorexia of ageing 328
References 329
28 Lower Gastrointestinal Disorders 331
Malabsorption 331
Inflammatory bowel disease 334
Diverticulosis 337
Mesenteric ischaemia 339
Constipation 341
Diarrhoea and faecal incontinence 343
Haemorrhoids 347
References 348
29 Abdominal Malignancies 351
Introduction 351
Epidemiology 351
Aetiology 354
Symptoms and signs 354
Therapy 355
Chemotherapy 357
Key points 359
Links 359
References 359
30 Liver Diseases in the Elderly 363
Introduction 363
Physiological changes associated with ageing 363
Drug induced liver disease 364
Cirrhosis 365
Alcoholic liver disease 366
Non-alcoholic steatohepatitis (NASH) 367
Hepatitis C 368
Hepatitis B 370
Liver transplantation 371
References 371
31 Disorders of the lower urinary tract 373
Pathophysiology 375
Incontinence subtypes 375
Treatment cessation 375
Assessment with a bearing on drug addition or withdrawal 376
Rectal examination 377
Vaginal examination 377
The pharmacological treatment of urinary incontinence 377
Cognition and antimuscarincs 379
Bladder outflow tract obstruction 379
Other pharmacological measures 380
Stress urinary incontinence 380
Summary 381
References 381
32 Management of Benign Prostatic Hyperplasia in Elderly Men 383
Assessment 383
Prostate specific antigen (PSA) 383
Urinary retention 383
Nocturnal frequency 385
Treatment 385
References 388
33 Management of Erectile Dysfunction in the Elderly 391
Introduction 391
Prevalence and aetiology of ED 391
Physical or psychogenic? 392
Diagnosis and assessment of ed in primary care 392
Treatment options 393
Key points 396
References 396
34 Benign Gynaecological Disorders 397
Urogenital atrophy 397
Prolapse 397
Traditional anatomical site prolapse classification 398
Urinary incontinence 400
Detrusor overactivity 400
Drug therapies 403
Lichen sclerosis 406
Lichen planus 407
References 407
35 Breast Cancer in Elderly Patients 411
Introduction 411
Presentation and diagnosis—special considerations in elderly patients 411
Management of breast cancer 412
Management of early breast cancer 413
Treatment of advanced breast cancer 413
Supportive care during breast cancer treatment 416
Breast cancer therapeutics in an elderly patient 416
Conclusion 416
Key points 416
References 420
36 Pharmacological Management of Endocrine Conditions in the Elderly Patient 421
Introduction 421
Diabetes aetiology 421
Diabetes symptoms and signs 422
Diabetes diagnosis 422
Type 2 diabetes management 423
Pharmacokinetic and pharmacodynamic data of diabetes medications in elderly patients 425
Clinically important drug interactions within diabetes drugs 426
General adverse effects of diabetes medications in elderly patients 426
Specific adverse effects and clinically-important drug interactions of diabetes drugs 427
Pituitary adenomas 427
Thyroid disease 428
Hyperparathyroidism 429
Hormone replacement 429
Endocrine disease in the elderly—key points 430
Further Reading 430
37 Rheumatoid Arthritis, Osteoarthritis, Polymyalgia Rheumatica, Gout and Pseudogout 433
Rheumatoid arthritis 433
Key points in rheumatoid arthritis 438
Osteoarthritis 438
Key points in osteoarthritis 441
Polymyalgia rheumatica 441
Key points in PMR 442
Gout and calcium pyrophosphate disease (CPPD) 443
Key points in gout and CPPD 446
Links 446
References 446
38 Falls, Osteoporosis, Paget’s Disease and Osteomalacia 449
Falls and osteoporosis 449
Paget’s disease 452
Osteomalacia 455
Key points 457
References 457
39 Drugs and Falls 459
Introduction 459
Pathophysiology 459
Fall-risk-increasing drugs 460
Clinical approach 462
Treatment: drug withdrawal 462
Key points 463
References 463
40 Pressure Ulcers 465
Introduction 465
The role of pressure in pressure ulcer development 465
The role of nutrition in pressure ulcer development 467
Risk assessment 467
Prevention 468
Local treatment 469
Key points 469
References 470
41 Leg Ulceration 471
Introduction 471
Aetiology 471
Symptoms and signs 473
Diagnosis 475
Therapy 478
Key points 482
Guidelines 482
References 482
42 Xerosis and Asteatotic Eczema 483
Xerosis 483
Actinic keratoses and Bowen’s disease 483
Bullous pemphigoid 484
Candidiasis 485
Erysipelas and cellulitis 486
Contact dermatitis 487
Herpes zoster (shingles) 488
Lichen planus 489
Malignant melanoma 490
Mycosis fungoides 491
Basal cell carcinoma and squamous cell carcinoma 492
Psoriasis 493
Scabies 494
Tinea 494
Urticaria and angio-oedema 495
Venous eczema and the dependency syndrome 496
43 Age-Related Eye Diseases 499
Cataract 499
Glaucoma 502
Age related macular degeneration 506
Diabetic retinopathy 512
References 514
44 Ear Disorders 515
Introduction 515
Hearing loss 515
Tinnitus 517
External otitis 519
Drugs causing hearing problems 520
References 521
45 Pain 523
Introduction 523
Aetiology 523
Diagnosis 524
Therapy 524
Key points 526
References 528
46 Palliative Care in the Elderly 529
Introduction 529
Symptoms 530
Palliative care in the elderly 530
Treatment of common symptoms in elderly patients 531
References 533
Index 535

Produkt-Details

• Erscheint lt. Verlag: 22.4.2009
• Sprache: englisch
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Geriatrie
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Pharmakologie / Pharmakotherapie
• Schlagworte: adverse • care professionals • Clearance • Comorbidities • Complex • differences • Drug • Drug Distribution • Due • Effects • elderly • Geriatric • geriatric medicine • Geriatrie • higher • Incidence • Interactions • likelihood • Medical Science • medication • Medizin • Neurologie • Neurology • Patient • patients • Pharmacology & Pharmaceutical Medicine • Pharmakologie u. Pharmazeutische Medizin • Prescribing • Risk • specifically
• ISBN-10: 0-470-02429-1 / 0470024291
• ISBN-13: 978-0-470-02429-4 / 9780470024294