Skip to main content
SpringerLink
Log in

Principles of Pharmacology

  • Chapter
Geriatric Medicine

Conclusion

As the most prominent consumers of prescription medications, elderly patients stand to benefit the most and are also at greatest risk of toxicity from our increasingly complex, effective, and costly pharmacopoeia. When pharmacotherapy is indicated, choosing the right drug in the right dose for an elderly patient represents one of the most difficult challenges in all of medicine, but also can yield the most gratifying outcomes. Likewise, few interventions in geriatric practice are as elegant in process, and as “heroic” in outcome, as identifying and treating adverse drug effects. Thorough knowledge of some of the principles outlined here will enable the clinician to wield this powerful double-edged sword with the least possible risk and with the maximum benefit for patients.

It is much easier to write upon a disease than upon a remedy. The former is in the hands of nature and a faithful observer with an eye of tolerable judgement cannot fail to delineate a likeness. The latter will ever be subject to the whim, the inaccuracies, and the blunder of mankind. William Withering, 1741–1799

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 299.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 379.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Schmucker DL. Aging and drug disposition: an update. Pharmacol Rev. 1985;37:133–148.

    PubMed  CAS  Google Scholar 

  2. Castleden CM, Volans CN, Raymond K, et al. The effect of ageing on drug absorption from the gut. Age Ageing. 1977;6:138–143.

    PubMed  CAS  Google Scholar 

  3. Schwartz JB. Clinical pharmacology. In: Hazzard WR, Bierman EL, Blass JP, Ettinger WH Jr, Halter JB, eds. Principles of Geriatric Medicine and Gerontology, 3rd Ed. New York: McGraw-Hill; 1994.

    Google Scholar 

  4. Campion EW, deLabry LO, Glynn RJ. The effect of age on serum albumin in healthy males: report from the Normative Aging Study. J Gerontol. 1988;43:M18–M20.

    PubMed  CAS  Google Scholar 

  5. Grandiston MK, Boudinot FD. Age-related changes in protein binding of drugs: implications for therapy. Clin Pharmacokinet. 2000;38:271–290.

    Article  Google Scholar 

  6. MacLennan WJ, Martin P, Mason BJ. Protein intake and serum albumin levels in the elderly. Gerontology. 1977; 23:360–367.

    PubMed  CAS  Google Scholar 

  7. Conti MC, Goralnik JH, Salive ME, Sarkin JD. Serum albumin level and physical disability as predictors of mortality in older persons. JAMA. 1994;272:1036–1042.

    Article  Google Scholar 

  8. Greenblatt DJ, Sellers EM, Koch-Weser J. Importance of protein binding for the interpretation of serum or plasma drug concentrations. J Clin Pharmacol. 1982;22:259–263.

    PubMed  CAS  Google Scholar 

  9. Frontera WR, Hughes VA, Lutz KJ, Evans WJ. A cross-sectional study of muscle strength and mass in 45-to 78-yr-old men and women. J Appl Physiol. 1991;71:644–650.

    PubMed  CAS  Google Scholar 

  10. Thurmann PA, Hompesch BC. Influence of gender on the pharmacokinetics and pharmacodynamics of drugs. Int J Clin Pharmacol Ther. 1998;36:586–590.

    PubMed  CAS  Google Scholar 

  11. Vestal RE. Aging and pharmacology. Cancer. 1997;80: 1302–1310.

    Article  PubMed  CAS  Google Scholar 

  12. Kinirons MT, Crome P. Clinical pharmacokinetic consid-erations in the elderly. Clin Pharmacokinet. 1997;33:302–312.

    PubMed  CAS  Google Scholar 

  13. Mooney H, Roberts R, Cooksley WGE, et al. Alterations in the liver with aging. Clin Gastroenterol. 1985;14:757–771.

    PubMed  CAS  Google Scholar 

  14. Vestal RE, Norris AH, Tobin JD, et al. Antipyrine metabolism in man: influence of age, alcohol, caffeine, and smoking. Clin Pharmacol Ther. 1975;18:425–432.

    PubMed  CAS  Google Scholar 

  15. Muhlberg W, Platt D. Age-dependent changes of the kidneys: pharmacological implications. Gerontology. 1999; 45:243–253.

    Article  PubMed  CAS  Google Scholar 

  16. Rowe JW, Andres R, Tobin JD, et al. The effect of age on creatinine clearance in man. J Gerontol. 1976;31:155–163.

    PubMed  CAS  Google Scholar 

  17. Lindeman RD, Tobin JD, Shock NW. Longitudinal studies on the rate of decline in renal function with age. J Am Geriatr Soc. 1985;33:278–285.

    PubMed  CAS  Google Scholar 

  18. Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron. 1976;16:31–41.

    Article  PubMed  CAS  Google Scholar 

  19. Friedman JR, Norman DC, Yoshikawa TT. Correlation of estimated renal function parameters versus 24-hour creatinine clearance in ambulatory elderly. J Am Geriatr Soc. 1989;37:145–149.

    PubMed  CAS  Google Scholar 

  20. Abernethy DR. Aging effects on drug disposition and effect. Geriatr Nephrol Urol. 1999;9:15–19.

    Article  PubMed  CAS  Google Scholar 

  21. Greenblatt DJ, Divoll M, Harmatz JS, et al. Kinetics and clinical effects of flurazepam in young and elderly insomniacs. Clin Pharmacol Ther. 1981;30:475–486.

    Article  PubMed  CAS  Google Scholar 

  22. Greenblatt DJ. Benzodiazepine hypnotics: sorting the pharmacokinetic facts. J Clin Psychiatry. 1991;52(suppl 9): 4–10.

    PubMed  Google Scholar 

  23. Ray WA, Griffin MR, Downey W. Benzodiazepines of long and short elimination half-life and the risk of hip fracture. JAMA. 1989;262:3303–3307.

    Article  PubMed  CAS  Google Scholar 

  24. Greenblatt DJ, Allen MD, Shader RI. Toxicity of high-dose flurazepam in the elderly. Clin Pharmacol Ther. 1977;21: 355–361.

    PubMed  CAS  Google Scholar 

  25. Greenblatt DJ, Harmatz JS, Shader RI. Clinical pharmacokinetics of anxiolytics and hypnotics in the elderly: therapeutic considerations (part I). Clin Pharmacokinet. 1991; 21:165–177.

    PubMed  CAS  Google Scholar 

  26. Turnheim K. Drug dosage in the elderly. Is it rational? Drugs Aging. 1998;13:357–379.

    Article  PubMed  CAS  Google Scholar 

  27. Greenblatt DJ, Harmatz JS, Shapiro L, Engelhardt N, Gouthro TA, Shader RI. Sensitivity to triazolam in the elderly. N Engl J Med. 1991;324:1691–1698.

    Article  PubMed  CAS  Google Scholar 

  28. Reidenberg MM, Levy M, Warner H, et al. Relationship between diazepam dose, plasma level, age, and central nervous system depression. Clin Pharmacol Ther. 1978; 23:371–374.

    PubMed  CAS  Google Scholar 

  29. Castleden CM, George CF, Marcer D, et al. Increased sensitivity to nitrazepam in old age. Br Med J. 1977;1:10–12.

    Article  PubMed  CAS  Google Scholar 

  30. Fischer M. Effect of age on pharmacokinetics and pharmacodynamics in man. Int J Clin Pharmacol Ther. 1998; 36:581–585.

    Google Scholar 

  31. Greenblatt DJ, Harmatz JS, Shader RI. Clinical pharmacokinetics of anxiolytics and hypnotics in the elderla: therapeutic considerations (part II). Clin Pharmacokinet. 1991;21:262–273.

    PubMed  CAS  Google Scholar 

  32. O’Malley K, Stevenson IH, Ward CA, et al. Determinants of anticoagulant control in patients receiving warfarin. Br J Clin Pharmacol. 1977;4:309–314.

    PubMed  CAS  Google Scholar 

  33. Shephard AMM, Hewick DS, Moreland TA. Age as a determinant of sensitivity to warfarin. Br J Clin Pharmacol. 1977;4:315–320.

    Google Scholar 

  34. Gurwitz JH, Avorn J, Ross-Degnan D, Choodnovskiy I, Ansell J. Aging and the anticoagulant response to warfarin. Ann Intern Med. 1992;116:901–904.

    PubMed  CAS  Google Scholar 

  35. Hammerlein A, Derendorf H, Lowenthal DT. Pharmacokinetic and pharmacodynamic changes in the elderly. Clinical implications. Clin Pharmacokinet. 1998; 35:49–64.

    Article  PubMed  CAS  Google Scholar 

  36. Greenblatt DJ, Shader RI, Harmatz JS. Implications of altered drug disposition in the elderly: studies of benzodiazepines. J Clin Pharmacol. 1989;29:866–872.

    PubMed  CAS  Google Scholar 

  37. Berlinger WG, Goldberg MJ, Spector R, Chiang CK, Ghoneim M. Diphenhydramine: kinetics and psychomotor effects in elderly women. Clin Pharmacol Ther. 1982;32:387–391.

    Article  PubMed  CAS  Google Scholar 

  38. Nolan L, O’Malley K. Prescribing for the elderly. Part I: Sensitivity of the elderly to adverse drug reactions. J Am Geriatr Soc. 1988;36:142–149.

    PubMed  CAS  Google Scholar 

  39. Gurwitz JH, Avorn J. The ambiguous relation between aging and adverse drug reactions. Ann Intern Med. 1991;114:956–966.

    PubMed  CAS  Google Scholar 

  40. Flaherty JH. Psychotherapeutic agents in older adults. Commonly prescribed and over-the-counter remedies: causes of confusion. Clin Geriatr Med. 1998;14:101–127.

    PubMed  CAS  Google Scholar 

  41. Larson EB, Kukull WA, Buchner D, et al. Adverse drug reactions associated with global cognitive impairment in elderly persons. Ann Intern Med. 1987;107:169–173.

    PubMed  CAS  Google Scholar 

  42. Cantu TG, Korek JS. Central nervous system reactions to histamine-2 receptor blockers. Ann Intern Med. 1991;114:1027–1034.

    PubMed  CAS  Google Scholar 

  43. Gray SL, Lai KV, Larson EB. Drug-induced cognition disorders in the elderly: incidence, prevention, and management. Drug Saf. 1999;21:101–122.

    Article  PubMed  CAS  Google Scholar 

  44. Verhaeverbeke I, Mets T. Drug-induced orthostatic hypotension in the elderly: avoiding its onset. Drug Saf. 1997;17:105–118.

    PubMed  CAS  Google Scholar 

  45. Sweet RA, Pollock BG. New atypical antipsychotics. Experience and utility in the elderly. Drugs Aging. 1998;12:115–127.

    Article  PubMed  CAS  Google Scholar 

  46. Chan YC, Pariser SF, Neufeld G. Atypical antipsychotics in older adults. Pharmacotherapy. 1999;19:811–822.

    Article  PubMed  CAS  Google Scholar 

  47. Cohen JS. Avoiding adverse reactions. Effective lowerdose drug therapies for older patients. Geriatrics. 2000;55: 54–56, 59–60, 63–64.

    PubMed  CAS  Google Scholar 

  48. Rochon PA, Gurwitz JH. Optimising drug treatment for elderly people: the prescribing cascade. Br Med J. 1997;315:1096–1099.

    CAS  Google Scholar 

  49. Gurwitz JH, Avorn J, Bohn RL, Glynn RJ, Monane M, Mogun H. Initiation of thiazide diuretic therapy during nonsteroidal anti-inflammatory drug therapy. JAMA. 1994;272:781–786.

    Article  PubMed  CAS  Google Scholar 

  50. Gurwitz JH, Kalish SC, Bohn RL, et al. Thiazide diuretics and the initiation of anti-gout therapy. J Clin Epidemiol. 1997;50:953–959.

    Article  PubMed  CAS  Google Scholar 

  51. Avorn J, Gurwitz JH, Bohn RL, et al. Increased incidence of levodopa therapy following metoclopramide use. JAMA. 1995;274:1780–1782.

    Article  PubMed  CAS  Google Scholar 

  52. Monane M, Avorn J, Beers MH, Everitt DE. Anticholinergic drug use and bowel function in nursing home patients. Arch Intern Med. 1993;153:633–638.

    Article  PubMed  CAS  Google Scholar 

  53. Rochon PA, Gurwitz JH. Drug therapy. Lancet. 1995;346: 32–36.

    Article  PubMed  CAS  Google Scholar 

  54. Ray WA, Griffin MR, Schaffner W, et al. Psychotropic drug use and the risk of hip fracture. N Engl J Med. 1987; 316:363–369.

    Article  PubMed  CAS  Google Scholar 

  55. Wang PS, Bohn RL, Glynn RJ, Mogun H, Avorn J. Zolpiderm use and hip fractures in older people. J Am Geriatr Soc. 2001;49:1685–1690.

    Article  PubMed  CAS  Google Scholar 

  56. Herings RMC, Stricker BHC, de Boer A, Bakker A, Sturmans A. Benzodiazepines and the risk of falling leading to femur fractures. Arch Intern Med. 1995;155:1801–1807.

    Article  PubMed  CAS  Google Scholar 

  57. Liu B, Anderson G, Mittmann N, To T, Axcell T, Shear N. Use of selective serotonin-reputake inhibitors of tricyclic antidepressants and risk of hip fractures in elderly people. Lancet. 1998;351:1303–1307.

    Article  PubMed  CAS  Google Scholar 

  58. Thapa PB, Gideon P, Cost TW, Milam AB, Ray WA. Antidepressants and the risk of falls among nursing home residents. N Engl J Med. 1998;339:875–882.

    Article  PubMed  CAS  Google Scholar 

  59. Thapa PB, Gideon P, Cost TW, Milam AB, Ray WA. Antidepressants and the risk of falls among nursing home residents. N Engl J Med. 1998;339:875–882.

    Article  PubMed  CAS  Google Scholar 

  60. Fifth ACCP Consensus Conference on Antithrombotic Therapy (1998): summary and recommendations. Chest 1998;114 (suppl):439S–769S.

    Google Scholar 

  61. Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation: a major contributor to stroke in the elderly. The Framingham Study. Arch Intern Med. 1987;147:1561–1564.

    Article  PubMed  CAS  Google Scholar 

  62. Feinberg WM, Blackshear J, Laupacis A, Kronmal R, Hart RG. Prevelance, age distribution, and gender of patients with atrial fibrillation: analysis and implications. Arch Intern Med. 1995;155:469–473.

    Article  PubMed  CAS  Google Scholar 

  63. Atrial Fibrillation Investigators. Risk factors for stroke and efficacy of antithrombotic therapy in atrial fibrillation: analysis of pooled data from five randomized controlled trials. Arch Intern Med. 1994;154:1449–1457.

    Article  Google Scholar 

  64. Hylek EM, Singer DE. Risk factors for intracranial hemorrhage in outpatients taking warfarin. Ann Intern Med. 1994;120:897–902.

    PubMed  CAS  Google Scholar 

  65. Fihn SD, McDonell M, Martin D, et al. Risk factors for complications of chronic anticoagulation: a multicenter study. Warfarin Optimized Outpatient Follow-up Study Group. Ann Intern Med. 1993;118:511–520.

    PubMed  CAS  Google Scholar 

  66. Kalish S, Gurwitz JH, Avorn J. Anticoagulant therapy in the elderly. Prim Cardiol. 1993;7:34–42.

    Google Scholar 

  67. Landefeld CS, Anderson PA. Guideline-based consultation to prevent anticoagulant-related bleeding. A randomized, controlled trial in a teaching hospital. Ann Intern Med. 1992;116:829–837.

    PubMed  CAS  Google Scholar 

  68. Poller L, Shiach CR, MacCallum PK, et al. Multicentre randomised study of computerised anticoagulant dosage. European Concerted Action on Anticoagulation. Lancet. 1998;352:1505–1509.

    Article  PubMed  CAS  Google Scholar 

  69. Gurwitz JH, Avorn J, Ross-Degnan D, Lipsitz LA. Nonsteroidal anti-inflammatory drug-associated azotemia in the very old. JAMA. 1990;264:471–475.

    Article  PubMed  CAS  Google Scholar 

  70. Bollini P, Garcia Rodriguez LA, Perez Gutthann S, Walker AM. The impact of research quality and study design on epidemiologic estimates of the effect of nonsteroidal anti-inflammatory drugs on upper gastrointestinal tract disease. Arch Intern Med. 1992;152:1289–1295.

    Article  PubMed  CAS  Google Scholar 

  71. Bradley JD, Brandt KD, Katz BP, Kalasinski LA, Ryan SI. Comparison of an antiinflammatory dose of ibuprofen, an analgesic dose of ibuprofen, and acetaminophen in the treatment of patients with osteoarthritis of the knee. N Engl J Med. 1991;325:87–91.

    Article  PubMed  CAS  Google Scholar 

  72. Whitcomb DC, Block GD. Association of acetaminophen hepatotoxicity with fasting and ethanol use. JAMA. 1994: 272:1845–1850.

    Article  PubMed  CAS  Google Scholar 

  73. Feldman M, McMahon AT. Do cyclooxygenase-2 inhibitors provide benefits similar to those of traditional nonsteroidal anti-inflammatory drugs, with less gastrointestinal toxicity? Ann Intern Med. 2000;132:134–143.

    PubMed  CAS  Google Scholar 

  74. Feldman M, McMahon AT. Do cyclooxygenase-2 inhibitors provide benefits similar to those of traditional nonsteroidal anti-inflammatory drugs, with less gastrointestinal toxicity? Ann Intern Med. 2000;132:134–143.

    PubMed  CAS  Google Scholar 

  75. Swan SK, Rudy DW, Lasseter KC, et al. Effect of cyclooxygenase-2 inhibition on renal function in elderly persons receiving a low-salt diet. Ann Intern Med. 2000;133:1–9.

    PubMed  CAS  Google Scholar 

  76. Strahan GW. An overview of nursing homes and their current residents: data from the 1995 national nursing homes survey. Advance Data from Vital and Health Statistics, no. 280. Hyattsville, MD: National Center for Health Statistics; 1997.

    Google Scholar 

  77. Bernabei R, Gambassi G, Lapane K, et al. Characteristics of the SAGE database: a new resource for research on outcomes in long-term care. SAGE (Systematic Assessment of Geriatric drug use via Epidemiology) Study Group. J Gerontol Ser A Biol Sci Med Sci. 1999;54:M25–M33.

    CAS  Google Scholar 

  78. Gerety MB, Cornell JE, Plichta DT, Eimer M. Adverse events related to drugs and drug withdrawal in nursing home residents. J Am Geriatr Soc. 1993;41:1326–1332.

    PubMed  CAS  Google Scholar 

  79. Gurwitz JH, Sanchez-Cross MT, Eckler MA, Matulis J. The epidemiology of adverse and unexpected events in long-term care setting. J Am Geriatr Soc. 1994;42:33–38.

    PubMed  CAS  Google Scholar 

  80. Gurwitz JH, Field TS, Avorn J, et al. Incidence and preventability of adverse drug events in nursing homes. Am J Med. 2000;109:87–94.

    Article  PubMed  CAS  Google Scholar 

  81. Rango N. Nursing home care in the United States. N Engl J Med. 1982;307:883–889.

    Article  PubMed  CAS  Google Scholar 

  82. Elon R, Paulson LG. The impact of OBRA on medical practice within nursing facilities. J Am Geriatr Soc. 1992; 40:958–963.

    PubMed  CAS  Google Scholar 

  83. Ray WA, Taylor JA, Meador KG, et al. A randomized trial of a consultation service to reduce falls in nursing homes. JAMA. 1997;278:557–562.

    Article  PubMed  CAS  Google Scholar 

  84. Avorn J, Soumerai SB, Everitt DE, et al. A randomized trial of a program to reduce the use of psychoactive drugs in nursing homes. N Engl J Med. 1992;327:168–173.

    Article  PubMed  CAS  Google Scholar 

  85. Ray WA, Taylor JA, Meador KG, et al. Reducing antipsychotic drug use in nursing homes. A controlled trial of provider education. Arch Intern Med. 1993;153:713–721.

    Article  PubMed  CAS  Google Scholar 

  86. Gurwitz JH, Monette J, Rochon PA, Eckler MA, Avorn J. Atrial fibrillation and stroke prevention with warfarin in the long-term care setting. Arch Intern Med. 1997;157:978–984.

    Article  PubMed  CAS  Google Scholar 

  87. Berwick DM. Continuous improvement as an ideal in health care. N Engl J Med. 1989;320:53–56.

    Article  PubMed  CAS  Google Scholar 

  88. Leape LL. Error in medicine. JAMA. 1994;272:1851–1857.

    Article  PubMed  CAS  Google Scholar 

  89. Leape LL, Bates DW, Cullen DJ, et al. Systems analysis of adverse drug events. JAMA. 1995;274:35–43.

    Article  PubMed  CAS  Google Scholar 

  90. Horton R. The uses of error. Lancet. 1999;353:422–423.

    Article  PubMed  CAS  Google Scholar 

  91. Teich JM, Merchia PR, Schmiz JL, Kuperman GJ, Spurr CD, Bates DW. Effects of computerized physician order enty on prescribing practices. Arch Intern Med. 2000;160:2741–2747.

    Article  PubMed  CAS  Google Scholar 

  92. Rothschild JM, Bates DW, Leape L. Preventable medical injuries in older patients. Arch Intern Med. 2000;160: 2717–2728.

    Article  PubMed  CAS  Google Scholar 

  93. Kohn LT, Corrigan JM, Donaldson MS, eds. To Err Is Human: Building a Safer Health System. Washington, DC: National Academy Press; 1999.

    Google Scholar 

  94. Bates DW, Leape LL, Cullen DJ, et al. Effect of computerized physician order entry and a team intervention on prevention of serious medication errors. JAMA. 1998; 280:1311–1316.

    Article  PubMed  CAS  Google Scholar 

  95. Beers MH, Ouslander JG, Rollingher I, Reuben DB, Brooks J, Beck JC. Expliit criteria for determining inappropriate medication use in nursing home residents. Arch Intern Med. 1991;151:1825–1832.

    Article  PubMed  CAS  Google Scholar 

  96. Beers MH. Explicit criteria for determining potentially inappropriate medication use by the elderly: an update. Arch Intern Med. 1997;157:1531–1536.

    Article  PubMed  CAS  Google Scholar 

  97. Gurwitz JH. Suboptimal medication use in the elderly. The tip of the iceberg. JAMA. 1994;272:292–296.

    Article  Google Scholar 

  98. Gonzales R, Steiner JF, Lum A, Barrett PH Jr. Decreasing antibiotic use in ambulatory practice: impact of a multidimensional intervention on the treatment of uncomplicated acute bronchitis in adults. JAMA. 1999;281: 1512–1519.

    Article  PubMed  CAS  Google Scholar 

  99. Gurwitz JH, Monette J, Rochon PA, Eckler MA, Avorn A. Atrial fibrillation and stroke prevention with warfarin in the long-term care setting. Arch Intern Med. 1997;157: 978–984.

    Article  PubMed  CAS  Google Scholar 

  100. Greenblatt DJ, Harmatz JS, Zinny MA, et al. Effect of gradual withdrawal on the rebound sleep disorder after discontinuation of triazolam. N Engl J Med. 1987;317:722–728.

    PubMed  CAS  Google Scholar 

  101. Busto U, Sellers EM, Naranjo CA, et al. Withdrawal reaction after long-term therapeutic use of benzodiazepines. N Engl J Med. 1986;315:854–859.

    Article  PubMed  CAS  Google Scholar 

  102. Danielson M, Lundback M. Withdrawal of antihypertensive drugs in mild hypertension. Acta Med Scand. 1981; 646(suppl 1):127–131.

    CAS  Google Scholar 

  103. Walma EP, Hoes AW, van Dooren C, Prins A, van der Does E. Withdrawal of long-term diuretic medication in elderly patients: a double blind randomised trial. Br Med J. 1997; 315:464–468.

    CAS  Google Scholar 

  104. Fleg JL, Gottlieb SH, Lakatta EG. Is digoxin really important in treatment of compensated heart failure? A placebo-controlled crossover study in patients with sinus rhythm. Am J Med. 1982;73:244–250.

    Article  PubMed  CAS  Google Scholar 

  105. Gheorghiade M, Beller GA. Effect of discontinuing maintenance digoxin therapy in patients with ischemic heart disease and congestive heart failure in sinus rhythm. Am J Cardiol. 1983;51:1243–1250.

    Article  PubMed  CAS  Google Scholar 

  106. Yusuf S, Garg R, Held P, Gorlin R. Need for a large randomized trial to evaluate the effects of digitalis on morbidity and mortality in congestive heart failure. Am J Cardiol. 1992;69:64G–70G.

    Article  PubMed  CAS  Google Scholar 

  107. Forman DE, Coletta D, Kenny D, et al. Clinical issues related to discontinuing digoxin therapy in elderly nursing home patients. Arch Intern Med. 1991;151:2194–2198.

    Article  PubMed  CAS  Google Scholar 

  108. Packer M, Gheorghiade M, Young JB, et al. Withdrawal of digoxin from patients with chronic heart failure treated with angiotensin-converting-enzyme inhibitors. N Engl J Med. 1993;329:1–7.

    Article  PubMed  CAS  Google Scholar 

  109. Rochon PA, Anderson GM, Tu JV, et al. Age and gender-relate use of low-dose drug therapy: the need to manufacture low-dose therapy and evaluate the minimum effective dose. J Am Geriatr Soc. 1999;47:954–959.

    PubMed  CAS  Google Scholar 

  110. Rochon PA, Tu JV, Anderson GM, et al. Rate of heart failure and 1-year survival for older people receiving low-dose beta-blocker therapy after myocardial infarction. Lancet. 2000;356:639–644.

    Article  PubMed  CAS  Google Scholar 

  111. Gurwitz JH, Gore JM, Goldberg RJ, et al., For the participants in the National Registry of Myocardial Infarction. Ann Intern Med. 1998;129:597–604.

    PubMed  CAS  Google Scholar 

  112. Rochon PA, Fortin PR, Dear KBG, Minaker KL, Chalmers TC. Reporting of age data in clinical trials of arthritis: deficiencies and solutions. Arch Intern Med. 1993;153:243–248.

    Article  PubMed  CAS  Google Scholar 

  113. Griffin MR, Piper JM, Daugherty JR, Snowden M, Ray WA. Nonsteroidal antiinflammatory drug use and increased risk for peptic ulcer disease in elderly persons. Ann Intern Med. 1991;114:257–263.

    PubMed  CAS  Google Scholar 

  114. Henry D, Lim LL, Garcia Rodriguez LA, et al. Variability in risk of gastrointestinal complications with individual non-steroidal anti-inflammatory drugs: results of a collaborative meta-analysis. Br Med J. 1996;312:1563–1566.

    CAS  Google Scholar 

  115. Gurwitz JH, Avorn J, Ross-Degnan D, Lipsitz LA. Non-steroidal anti-inflammatory drug-associated azotemia in the very old. JAMA. 1990;264:471–475.

    Article  PubMed  CAS  Google Scholar 

  116. Gurwitz JH, Avorn J, Bohn RL, Glynn RJ, Monane M, Mogun H. Initiation of antihypertensive treatment during nonsteroidal anti-inflammatory drug therapy. JAMA. 1994;272:781–786.

    Article  PubMed  CAS  Google Scholar 

  117. Schumann K. Interactions between drugs and vitamins at advanced age. Int J Vitam Nutr Res. 1999;69:173–178.

    Article  PubMed  CAS  Google Scholar 

  118. Coleman LM, Fowler LL, Williams ME. Use of unproven therapies by people with Alzheimer’s disease. J Am Geriatr Soc. 1995;43(7):747–750.

    PubMed  CAS  Google Scholar 

  119. Fugh-Berman A. Herb-drug interactions. Lancet. 2000; 355:134–138.

    Article  PubMed  CAS  Google Scholar 

  120. Gold JL, Laxer DA, Dergal JM, Lanctot KL, Rochon PA. Herb-drug therapy interactions: A focus on dementia. Curr Opin Clin Nutr Metab Care. 2001;4(1):29–34.

    PubMed  CAS  Google Scholar 

  121. Rochon PA, Gurwitz JG. Prescribing for seniors: neither too much nor too little. JAMA. 1999;282:113–115.

    Article  PubMed  CAS  Google Scholar 

  122. Mitchell JB. Physician visits to nursing homes. Gerontologist. 1982;22:45–48.

    PubMed  CAS  Google Scholar 

  123. Gurwitz JH, Soumerai SB, Avorn J. Improving medication prescribing and utilization in the nursing home. J Am Geriatr Soc. 1990;38:542–552.

    PubMed  CAS  Google Scholar 

  124. Anonymous. Conditions of participation-pharmaceutical services. Fed Reg. 1974;39:12–17.

    Google Scholar 

  125. Ray WA, Federspiel CF, Schaffner W. A study of antipsychotic drug use in nursing homes: epidemiologic evidence suggesting misuse. Am J Public Health. 1980;70:485–491.

    Article  PubMed  CAS  Google Scholar 

  126. Ingman SR, Lawron IR, Pierpaoli PG, et al. A survey of the prescribing and administration of drugs in a long-term care institution for the elderly. J Am Geriatr Soc. 1975;23: 309–316.

    PubMed  CAS  Google Scholar 

  127. Beers M, Avorn J, Soumerai SB, et al. Psychoactive medication use in intermediate-care facilities. JAMA. 1988;260:3016–3020.

    Article  PubMed  CAS  Google Scholar 

  128. Buck JA. Psychotropic drug practice in nursing homes. J Am Geriatr Soc. 1988;36:409–418.

    PubMed  CAS  Google Scholar 

  129. Schneider LS, Pollock VE, Lyness SA. A metaanalysis of controlled trials of neuroleptic treatment in dementia. J Am Geriatr Soc. 1990;38:553–563.

    PubMed  CAS  Google Scholar 

  130. Avorn J, Soumerai SB, Everitt DE, et al. A randomized trial of a program to reduce the use of psychoactive drugs in nursing homes. N Engl J Med. 1992;327:168–173.

    Article  PubMed  CAS  Google Scholar 

  131. Everitt DE, Fields DR, Soumerai SS, Avorn J. Resident behavior and staff distress in the nursing home. J Am Geriatr Soc. 1991;39:792–798.

    PubMed  CAS  Google Scholar 

  132. Ray WA, Taylor JA, Meador KH, et al. Reducing antipsychotic drug use in nursing homes: a controlled trial of provider education. Arch Intern Med. 1993;153:713–721.

    Article  PubMed  CAS  Google Scholar 

  133. Svarstad BL, Mount JK. Nursing home resources and tranquilizer use among the institutionalized elderly. J Am Geriatr Soc. 1991;39:869–875.

    PubMed  CAS  Google Scholar 

  134. Rich MW, Beckham V, Wittenberg C, Leven CL, Greedland KE, Carney RM. A multidisciplinary intervention to prevent the readmission of elderly patients with congestive heart failure. N Engl J Med. 1995;333:1213–1214.

    Article  Google Scholar 

  135. Tinetti ME, Baker DI, McAvay G, et al. A multifactorial intervention to reduce the risk of falling among elderly people living in the community. N Engl J Med. 1994;331: 872–873.

    Article  Google Scholar 

  136. Elston Lafata J, Martin SA, Kaatz S, Ward RE. The cost-effectiveness of different management strategies for patients on chronic warfarin therapy. J Gen Intern Med. 2000;15:31–37.

    Article  Google Scholar 

  137. SHEP Cooperative Research Group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension: final results of the Systolic Hypertension in the Elderly Program (SHEP). JAMA. 1991;265:3255–3264.

    Article  Google Scholar 

  138. Gurwitz JH, Col NF, Avorn J. The exclusion of the elderly and women from clinical trials in acute myocardial infarction. JAMA. 1991;268:1417–1422.

    Article  Google Scholar 

  139. Sacks FM, Pfeffer MA, Moye LA, et al. The effect of pravastatin on coronary events after myocardial infraction in patients with average cholesterol levels. N Engl J Med. 1996;335:1001–1009.

    Article  PubMed  CAS  Google Scholar 

  140. Lewis SJ, et al. Effect on pravastatin on cardiovascular events in older patients with myocardial infraction and cholesterol levels in the average range. Ann Intern Med. 1998;129:681–689.

    PubMed  CAS  Google Scholar 

  141. Ganz DA, Kuntz KM, Jacobson GA, Avorn J. Cost-effectiveness of 3-hydroxy-3-methylglutaryl coenzyme A reducatase inhibitor therapy in older patients with myocardial infraction. Ann Intern Med. 2000;132:780–787.

    PubMed  CAS  Google Scholar 

  142. Shepherd J, et al. The design of a prospective study of pravastatin in the elderly at risk (PROSPER). Am J Cardiol. 1999;84:1192–1197.

    Article  PubMed  CAS  Google Scholar 

  143. Guideline for the Study of Drugs Likely to Be Used in the Elderly. Rockville, MD: Center for Drug Evaluation and Research, Food and Drug Administration; 1989.

    Google Scholar 

Download references

Authors
  1. Jerry Avorn
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jerry H. Gurwitz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Paula Rochon
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

Copyright information

© 2003 Springer-Verlag New York, Inc.

About this chapter

Cite this chapter

Avorn, J., Gurwitz, J.H., Rochon, P. (2003). Principles of Pharmacology. In: Geriatric Medicine. Springer, New York, NY. https://doi.org/10.1007/0-387-22621-4_7

Download citation

  • DOI: https://doi.org/10.1007/0-387-22621-4_7

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-0-387-95514-8

  • Online ISBN: 978-0-387-22621-7

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation