An overview of adverse effects of antimuscarinic agents in the elderly

A 79-year-old man presented to the emergency department with a 1-week history of worsening confusion, falls and hearing impairment. An initial workup for infectious, metabolic and structural causes was unrevealing. However, further history discovered that he had been ingesting one to two bottles of Pepto-Bismol (bismuth subsalicylate) daily for gastro-oesophageal reflux symptoms. On his second day of admission, the plasma salicylate concentration was 2.08 mmol/L (reference range 1.10–2.20 mmol/L), despite no sources of salicylate in hospital. He was diagnosed with chronic salicylate toxicity and Pepto-Bismol use was discontinued. The patient was treated supportively with isotonic intravenous fluids only and plasma salicylate concentration fell to less than 0.36 mmol/L. Concurrently, all his symptoms resolved. This case highlights the potential adverse effects of over-the-counter medications. The diagnosis of chronic salicylate toxicity is challenging, specifically in the elderly and in undifferentiated presentations, as it can be missed if not suspected.

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Perioperative Multimodal Anesthesia Using Regional Techniques in the Aging Surgical Patient

Pain Research and Treatment ◽

10.1155/2014/902174 ◽

2014 ◽

Vol 2014 ◽

pp. 1-13 ◽

Cited By ~ 5

Author(s):

Diana Nordquist ◽

Thomas M. Halaszynski

Keyword(s):

Drug Therapy ◽

Adverse Effects ◽

Elderly Patients ◽

Regional Anesthesia ◽

Pain Control ◽

The Elderly ◽

Surgical Patient ◽

Cochrane Central Register ◽

Promising Alternative ◽

Age Related

Background. Elderly patients have unique age-related comorbidities that may lead to an increase in postoperative complications involving neurological, pulmonary, cardiac, and endocrine systems. There has been an increase in the number of elderly patients undergoing surgery as this portion of the population is increasing in numbers. Despite advances in perioperative anesthesia and analgesia along with improved delivery systems, monotherapy with opioids continues to be the mainstay for treatment of postop pain. Reliance on only opioids can oftentimes lead to inadequate pain control or increase in the incidence of adverse events. Multimodal analgesia incorporating regional anesthesia is a promising alternative that may reduce needs for high doses and dependence on opioids along with any potential associated adverse effects. Methods. The following databases were searched for relevant published trials: Cochrane Central Register of Controlled Trials and PubMed. Textbooks and meeting supplements were also utilized. The authors assessed trial quality and extracted data. Conclusions. Multimodal drug therapy and perioperative regional techniques can be very effective to perioperative pain management in the elderly. Regional anesthesia as part of multimodal perioperative treatment can often reduce postoperative neurological, pulmonary, cardiac, and endocrine complications. Regional anesthesia/analgesia has not been proven to improve long-term morbidity but does benefit immediate postoperative pain control. In addition, multimodal drug therapy utilizes a variety of nonopioid analgesic medications in order to minimize dosages and adverse effects from opioids while maximizing analgesic effect and benefit.

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Elderly and drugs: risks and necessity of rational use

Brazilian Journal of Pharmaceutical Sciences ◽

10.1590/s1984-82502010000400003 ◽

2010 ◽

Vol 46 (4) ◽

pp. 617-632 ◽

Cited By ~ 9

Author(s):

André de Oliveira Baldoni ◽

Farah Maria Drumond Chequer ◽

Elisa Raquel Anastácio Ferraz ◽

Danielle Palma de Oliveira ◽

Leonardo Régis Leira Pereira ◽

...

Keyword(s):

Quality Of Life ◽

Adverse Effects ◽

Elderly Population ◽

Adverse Drug Events ◽

The Elderly ◽

External Factors ◽

Access To Information ◽

Inappropriate Use ◽

The World

In recent decades, the world has undergone a demographic transformation with a rapid growth of the elderly population, resulting in an increased demand for funds to maintain their health and drug consumption. Pharmacokinetic and pharmacodynamic changes occurring in the elderly can interfere directly in the adverse effects of drugs and increase the risk of intoxication. In addition, there are external factors interfering with the pharmacotherapy of the elderly, such as inappropriate use and the lack of access to information. Many therapeutic classes of drugs should be used with caution or avoided in the elderly population, such as anti-inflammatory and some anti-hypertensive drugs, diuretics and digitalis. If not managed carefully, these medicines can affect the safety and quality of life in the elderly. Thus, the aim of this review was to identify drugs that should be used with caution in elderly patients in order to avoid intoxication and/or adverse drug events.

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Baseline Plasma GABA: Its Relationship to the Adverse Effects of Acute Lorazepam Administration on Cognition in the Elderly

Neurochemical Research ◽

10.1007/s11064-004-7041-3 ◽

2004 ◽

Vol 29 (12) ◽

pp. 2311-2315 ◽

Cited By ~ 2

Author(s):

Nunzio Pomara ◽

Lisa M. Willoughby ◽

John J. Sidtis ◽

P. Murali Doraiswamy ◽

Keith A. Wesnes ◽

...

Keyword(s):

Adverse Effects ◽

The Elderly

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Ethics in Clinical Studies: The Dilemma of very Young and Old

10.46610/jcper.2021.v03i02.005 ◽

2021 ◽

Vol 3 (2) ◽

Author(s):

Avisek Dutta ◽

Avisek Dutta

Keyword(s):

Clinical Trial ◽

Clinical Trials ◽

Human Physiology ◽

Informed Consent ◽

Adverse Effects ◽

Age Groups ◽

The Elderly ◽

Infantile Spasms ◽

Care Givers ◽

Improve Health

The objectives of the research are to percolate knowledge which can improve health and improve understanding of human physiology. Pervasive exclusion of children and elderly in clinical trials as is happening today is not justified. Children have different physiology and pharmacology from adults; often adverse effects are also different and specific. Diseases like neonatal hyperbilirubinemia, infantile spasms are very age specific. Elderly too, have age specific issues like dementias, malignancies, weakened systems and polypharmacy that make them a special cohort. Clinical trials in these age groups are essential so as to gather comprehensive data about a medication across all age groups. Informed consent is a challenge in both these groups. It can be remedied by obtaining consent from parents, or legally acceptable representative in case of children and care givers and/or LARs in case of the elderly. Oral assent from 7 to 11 years, and written assent from 12 to 18 years and in the elderly, along with consent from the LAR, parents, care givers as the case may be, forms the bedrock of good clinical trial ethics.

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Non-Steroidal Anti-Inflammatory Drugs: Usage and Co-prescription with Other Potentially Interacting Drugs in Elderly: a Cross-sectional Study

10.21203/rs.2.19183/v1 ◽

2019 ◽

Author(s):

Nuru Abdu ◽

Samuel Teweldemedhin ◽

Asmerom Mosazghi ◽

Luwam Asfaha ◽

Makda Teshale ◽

...

Keyword(s):

Adverse Effects ◽

Drug Interactions ◽

The Elderly ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Female Ratio ◽

Protective Agents ◽

Inflammatory Drugs ◽

Anti Inflammatory

Abstract Introduction: Globally, non-steroidal anti-inflammatory drugs (NSAIDs) usage in the elderly with chronic pain has been reported as frequent. Though it is fundamental in maintaining their quality of life, the risk of polypharmacy, drug interactions and adverse effects is of paramount importance as the elderly usually require multiple medications for their co-morbidities. If prescriptions are not appropriately monitored and managed, they are likely to expose patients to serious drug interactions and potentially fatal adverse effects. Thus, the objective of the study was to assess the appropriateness of NSAIDs use and incidence of NSAIDs related potential interactions in elderly. Methods: A descriptive cross-sectional study was conducted among elderly out-patients (aged 60 and above) who visited three hospitals in Asmara between August 22 and September 29, 2018. The sampling design was two-stage random sampling and data was collected using a questionnaire, exit interview and by abstracting information from patients’ clinical cards. Descriptive and analytical statistics including chi-square test and logistic regression were employed using SPSS. Results: A total of 285 elderly respondents were enrolled in the study with similar male to female ratio. One in four of all respondents were chronic NSAIDs users, of which 74.6% were not prescribed prophylactic gastro-protective agents (GPAs). About 20% of the elderly were involved in polypharmacy and nearly all of the encountered potential NSAIDs related interactions (n=322) with prescribed drugs were moderate. Diabetes and hypertension were significantly associated with chronic NSAIDs use (OR=3, 95% CI: 1.54, 5.84; OR=9.99, 95% CI: 4.46, 22.38) and incidence of drug interactions (OR=3.95, 95%CI: 1.92, 8.13; OR=3.12, 95%CI: 1.81, 5.33) while diabetes and cardiac problem were significantly associated with incidence of polypharmacy (OR=4.33, 95% CI: 2.36, 7.96; OR=3.56, 95% CI: 1.05, 12.11). Conclusion: Though the overall reflection of prescription pattern of NSAIDs during the study period was almost satisfactory, gastro-protective agents were poorly prescribed as a prophylaxis.

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Clearing Up the Confusion: ADVERSE EFFECTS OF MEDICATIONS in the Elderly

Journal of Gerontological Nursing ◽

10.3928/0098-9134-19911001-09 ◽

1991 ◽

Vol 17 (10) ◽

pp. 32-35 ◽

Cited By ~ 4

Author(s):

Dorothy T Palmieri

Keyword(s):

Adverse Effects ◽

The Elderly

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How I treat elderly patients with myeloma

Blood ◽

10.1182/blood-2009-10-163329 ◽

2010 ◽

Vol 116 (13) ◽

pp. 2215-2223 ◽

Cited By ~ 25

Author(s):

Jayesh Mehta ◽

Michele Cavo ◽

Seema Singhal

Keyword(s):

Adverse Effects ◽

Older Patients ◽

Supportive Therapy ◽

The Elderly ◽

High Dose Chemotherapy ◽

Cytotoxic Agents ◽

High Dose ◽

Clinical Approach ◽

Younger Patients ◽

Best Response

Abstract The clinical approach to older patients with myeloma has to be modified to take into account comorbidities and the likelihood of higher treatment-related toxicity. Individualization of management and adequate supportive therapy are important to obtain the best response while minimizing adverse effects. Corticosteroids, novel agents, conventional cytotoxic agents, and high-dose chemotherapy with autotransplantation (modalities used in younger patients) are also used in older patients, although the elderly undergo transplantation less frequently. The sequential use of active agents singly and in different combinations has improved response rates and survival of all patients with myeloma, including the elderly.

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