Polypharmacy and Potentially Inappropriate Medication Use Among Elders with Dementia

Chapter

Abstract

Senior patients are at hight risk of polymorbidity which may correspond with hight risk of polypharmacy. Benefit of pharmacotherapy on one hand and risk of pharmacotherapy on the other hand are two different scales of one balance we have to measure on.

The paper shows basic principles of safe and efficient pharmacotherapy in the elderly – including inappropriate psychotropic drugs and drug-drug interactions which should be avoided.

Keywords

Geriatric Medicine Geriatric Psychiatry Inappropriate Medication Confusional State Adjustment Disorder 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Abbreviations

BZD

benzodiazepines

CYP

cytochrome P450 superfamily

ECG

electrocardiography

MAO inhibitors

monoamine oxidase inhibitors

MASSA

melatonin agonist and selective serotonin antagonist

NASSA

noradrenergic and specific serotonergic antidepressant

NDRI

noradrenergic and dopaminergic reuptake inhibitor

NSAID’s

nonsteroid anti-inflammatory drugs

QT

QT interval in electrocardiogram

SARI

serotonin antagonist reuptake inhibitor

SIADH

syndrome of inappropriate antidiuretic hormone secretion

SNRI

serotonin noradrenaline reuptake inhibitors

SSRI

selective serotonin reuptake inhibitors

TCA’s

tricyclic antidepressants

Z”-agents

zolpidem zopiclone, zaleplone

Notes

Acknowledgement

The paper was not supported by any grant or other financial support. Ethical hazard is therefore excluded.

References

  1. 1.
    Luzny J, Bellova J, Donek E (2010) Does gerontopsychiatry belong to medicine? cross-­sectional study monitoring polymorbidity in hospitalized gerontopsychiatric patiens. Biomed Pap Med Fac Univ Palacky Czech Repub 154(1):89–92CrossRefGoogle Scholar
  2. 2.
    Shi S, Morike K, Klotz U (2008) The clinical implications of ageing for rational drug therapy. Eur J Clin Pharmacol 64:183–199PubMedCrossRefGoogle Scholar
  3. 3.
    Turnheim K (2000) Pharmacokinetic dosage guidelines for elderly subjects. Expert Opin Drug Metab Toxicol 1:33–48CrossRefGoogle Scholar
  4. 4.
    Gurwitz JH, Avorn J (1991) The ambiguous relation between aging and adverse drug ­reactions. Ann Intern Med 114:956–966PubMedGoogle Scholar
  5. 5.
    Balducci L, Extermann M (2000) Management of cancer in the older person: a practical approach. Oncologist 5:224–237PubMedCrossRefGoogle Scholar
  6. 6.
    Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, McBurnie MA (2001) Cardiovascular health study collaborative research group [6]: frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 56:M146–M156PubMedCrossRefGoogle Scholar
  7. 7.
    Topinkova E (2005) Geriatrie pro praxi [Geriatrics for practice], 1st edn. Galen, Praha, pp 13–17Google Scholar
  8. 8.
    Kalvach Z, Onderková A (2006) Stáří. Pojetí geriatrického pacienta a jeho problémů v ošetřovatelské praxi. [Ageing. Concept of geriatric patient and his problems in nursing ­practice], 1st edn. Galen, Praha, pp 10–18Google Scholar
  9. 9.
    Spar JE, La Rue A (2002) Concise guide to geriatric psychiatry, 3rd edn. American Psychiatric Publishing, Washington, DC/London, pp 364–366Google Scholar
  10. 10.
    Sadock BJ, Kaplan HI, Sadock VA (2007) Kaplan and Sadock’s synopsis of psychiatry, 10th edn. Lippincot Williams and Wilkins, Wolters Kluwer Business, Philadelphia, pp 1003–1007Google Scholar
  11. 11.
    Semple D, Smyth R, Burns J et al (2005) Oxford handbook of psychiatry, 1st edn. Oxford University Press, New York, pp 333–339Google Scholar
  12. 12.
    Luzny J, Ivanova K (2009) Quality of life in hospitalized seniors with psychiatric disorders (a cross-sectional study from the Kromeriz District, Czech Republic). Biomed Pap Med Fac Univ Palacky Czech Repub 153(4):315–318CrossRefGoogle Scholar
  13. 13.
    Tyrer P, Silk KR (2011) Effective treatments in psychiatry, 1st edn. Cambridge University Press, Cambridge, pp 25–26CrossRefGoogle Scholar
  14. 14.
    Cohen GD (1993) African American Issues in geriatric psychiatry: a perspective on research opportunities. J Geriatr Psychiatry Neurol 6(4):195–199PubMedGoogle Scholar
  15. 15.
    Engedal K et al (1991) Psychiatry for the elderly – a speciality field in progress. Tidsskr Nor Laegeforen 111(18):2258–2260PubMedGoogle Scholar
  16. 16.
    Nieuwenhuijzen K, Mulder WJ, Pijpers E (2007) Ageing and polymorbidity: is there a ­ mismatch between the training of internists and the need? Neth J Med 65(10):363–365Google Scholar
  17. 17.
    Ivanova K, Spirudova L, Kutnohorska J (2005) Multikulturní ošetřovatelství. [Multicultural nursing], 1st edn. Grada, Praha, pp 12–15 (In Czech)Google Scholar
  18. 18.
    Ivanova K, Klos R (2004) Kapitoly z lékařské etiky. [Chapters from medical ethics], 1st edn. Palacky University, Olomouc, pp 99–103 (In Czech)Google Scholar
  19. 19.
    Rosenfeld S (2003) Prevalence, associated factors, and misuse of medication in the elderly: a review. Cad Saude Publica 19:717–724CrossRefGoogle Scholar
  20. 20.
    Frankfurt SV, Tulner LR, van Campen JP, Koks CH, Beijnen JH (2006) Evaluation of pharmacotherapy in geriatric patients after performing complete geriatric assessment at a diagnostic day clinic. Clin Drug Investig 26:169–174CrossRefGoogle Scholar
  21. 21.
    Stahl MS (2002) Essential psychopharmacology. Neuroscientific basis and practical applications, 2nd edn. Cambridge University Press, Cambridge, pp 588–591Google Scholar
  22. 22.
    Henn F, Sartorius N, Helmchen H, Lauter H (2001) Contemporary psychiatry, 1st edn. Springer, Berlin, pp 1982–1987Google Scholar
  23. 23.
    Vonbach P, Dubied A, Krahenbuhl S, Beer JH (2008) Prevalence of drug-drug interactions at hospital entry and during hospital stay of patients in internal medicine. Eur J Intern Med 19:413–420PubMedCrossRefGoogle Scholar
  24. 24.
    Zlámal J, Ulrich M (2008) Základy ekonomie pro management zdravotnictví. [Basic economy for management of health care], 1st edn. Palacky University, Olomouc, pp 15–16 (In Czech)Google Scholar
  25. 25.
    Janicak PG (1999) Handbook of psychopharmacotherapy, 1st edn. Lippincott Williams and Wilkins, London, pp 122–125Google Scholar
  26. 26.
    Aronson JK, Grahame S, Grahame D (2004) Oxford textbook of clinical pharmacology and drug therapy, 3rd edn. Oxford University Press, Oxford, pp 17–19Google Scholar
  27. 27.
    Mackenzie B, Souza RP, Likhodi O et al (2010) Pharmacogenetics of antipsychotic treatment response and side effects. Therapy 7(2):191–198PubMedCrossRefGoogle Scholar
  28. 28.
    Schatzberg AF, Cole JO, DeBattista C (2003) Manual of clinical psychopharmacology, 1st edn. American Psychiatric Publishing, Inc, Washington, DC, pp 688–690Google Scholar
  29. 29.
    Gelder MG, Lopez-Ibor JJ, Andreasen NC (2003) New Oxford textbook of psychiatry, 1st edn. Oxford University Press, New York, pp 2111–2117Google Scholar
  30. 30.
    Holt S, Schmiedl S, Thurmann PA (2010) Potentially inappropriate medications in the elderly: the PRISCUS list. Dtsch Arztebl Int 107(31–32):543–551PubMedGoogle Scholar
  31. 31.
    Shiloh R, Nutt D, Wiezman A (2003) Essentials in clinical psychiatric pharmacotherapy, 1st edn. Martin Dunitz, London, pp 104–108Google Scholar
  32. 32.
    Zieglmeier M, Hein T (2003) Interaktionen. Wirkstoffbezogene, beratungsemplepfehlungen fur die Praxis, 1st edn. Wissenschaftliche Verlagsgesellschaft mbH, Stuttgart, pp 120–132Google Scholar
  33. 33.
    Luzny J (2012) Psychogeriatry, 1st edn. Triton, Praha, pp 15–17Google Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  1. 1.Mental Hospital Kromeriz and Palacky University OlomoucPrahaCzech Republic

Personalised recommendations