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Drug-Drug Interactions in the Elderly

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1. CRACKCast E182 – Drug Therapy in the Geriatric Patient

, as it will no doubt help you on your next shift. Shownotes – Rosen’s In Perspective The elderly are coming in droves! Drug therapy issues are particularly challenging in older adults because of altered pharmacokinetics and pharmacodynamics compared to younger adults. In addition, they take more medications, have more comorbidities, and are at increased risk for adverse drug effects because of the physiologic changes of aging As a result, medication selection and dosing need to be age-adapted for optimal patient (...) CRACKCast E182 – Drug Therapy in the Geriatric Patient CRACKCast E182 - Drug Therapy in the Geriatric Patient - CanadiEM CRACKCast E182 – Drug Therapy in the Geriatric Patient In , by Chris Lipp May 31, 2018 This episode of CRACKCast covers Rosen’s chapter 185, Drug Therapy in the Geriatric Patient. Although short, this post contains vital information that will help you optimize the care of yours elderly patients in the ED. Take some time to commit this information to memory

2018 CandiEM

2. Brolucizumab–dbll (Beovu) - wet age-related macular degeneration

provide pivotal or supportive evidence of effectiveness? 9 3.3.2 Is the proposed dosing regimen appropriate for the general patient population for which the indication is being sought? 9 3.3.3 Is an alternative dosing regimen and/or management strategy required for subpopulations based on intrinsic factors? 9 3.3.4 Are there clinically relevant food-drug or drug-drug interactions and what is the appropriate management strategy? 10 4. APPENDICES 10 4.1 Summary of Bioanalytical Method Validation (...) , or mild to moderate renal 3 See Section 4.4 for Definitions/Glossaries Reference ID: 447199310 impairment (measured based on glomerular filtration rate (GFR)= 30 to 70 mL/min, estimated using the Modification of Diet in Renal Disease (MDRD) equation). 3.3.4 Are there clinically relevant food-drug or drug-drug interactions and what is the appropriate management strategy? - The drug product is given via IVT injection; therefore, the issue of a food-drug interaction is not relevant. - No drug-drug

2019 FDA - Drug Approval Package

3. Use of multiple micronutrient powders for point-of-use fortification of foods consumed by infants and young children aged 6?23 months and children aged 2?12 years

and vector-control programmes), prompt diagnosis of malaria illness, and treatment with effective antimalarial drug therapy. • If sugar is fortified with vitamin A, vitamin A should be excluded from the multiple micronutrient powders. If other staple foods regularly consumed by children (e.g. oil) are fortified with vitamin A, the risk of inadequate and high intakes of vitamin A should be assessed and the decision to include or exclude vitamin A from the multiple micronutrient powders should be based (...) and then have timely introduction of adequate and safe complementary foods, while continuing breastfeeding up to 2 years of age (23). Several countries are implementing or planning to implement point-of-use fortification programmes that provide multiple micronutrient powders to infants older than 6 months of age and children up to 12 years of age (24). Countries should have a national strategy for control and prevention of micronutrient deficiency. For the specific case of prevention and control of iron

2017 World Health Organisation Guidelines

4. Clinical Practice Guideline for the Treatment of Depression Across Three Age Cohorts

First Street, NE, Washington, DC 20002-4242. E-mail: cpg@apa.org. APA GUIDELINE FOR THE TREATMENT OF DEPRESSION ii Abstract The American Psychological Association (APA) developed this clinical practice guideline to provide recommendations for the treatment of depressive disorders (including major depression, subsyndromal depression, and persistent depressive disorder). It addresses three developmental cohorts: children and adolescents; general adults; and older adults (ages 60 and over). Ten (...) Across Three Age Cohorts 1 Scope of the Problem 1 Children and Adolescents 2 General Adult Population 11 Older Adult Population 14 The Need for a Clinical Practice Guideline and Decisions about Scope and Goals of the Clinical Practice Guideline 18 The APA Clinical Practice Guideline for the Treatment of the Problem 19 Guideline Purpose and Scope: What the Guideline Does and Does Not Address 23 APA GUIDELINE FOR THE TREATMENT OF DEPRESSION iv Process and Method 26 Vetting and Appointment of Members

2019 American Psychological Association

5. AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol

and drugdrug interactions; consideration of costs of statin therapy; and patient preferences and values in shared decision-making. 7. In adults 40 to 75 years of age without diabetes mellitus and with LDL-C levels =70 mg/dL (=1.8 mmol/L), at a 10-year ASCVD risk of =7.5%, start a moderate-intensity statin if a discussion of treatment options favors statin therapy. Risk-enhancing factors favor statin therapy (see No. 8). If risk status is uncertain, consider using coronary artery calcium (CAC (...) Assistants (AAPA), Association of Black Cardiologists (ABC), American College of Preventive Medicine (ACPM), American Diabetes Association (ADA), American Geriatrics Society (AGS), American Pharmacists Association (APhA), American Society for Preventive Cardiology (ASPC), National Lipid Association (NLA), and Preventive Cardiovascular Nurses Association (PCNA). Appendix 1 of the present document lists writing committee members’ relevant relationships with industry and other entities. For the purposes

2018 American College of Cardiology

6. Improving Quality of Life: Substance Use and Aging

the impact of aging on pharmacokinetics (the actions of the body on drugs), looking at how drug absorption, distribution, metabolism, and excretion and elimination processes change in older adulthood. In some cases, pharmacodynamic and pharmacokinetic changes associated directly with aging can increase the likelihood of harmful drugdrug interactions or toxicity. In addition, problematic drug use places additional stress on the body’s systems (which are already more vulnerable with age) and reduces (...) Improving Quality of Life: Substance Use and Aging SUBSTANCE USE IN CANADA 2018 Improving Quality of Life: Substance Use and Aging Foreword by Rita Notarandrea Foreword by Samuel Weiss Introduction Terminology Notes Improving Quality of Life: Substance Use and Aging PRINCIPAL EDITORS Alastair J. Flint, MB, FRCPC, FRANZCP Professor and Vice-Chair, Research, Department of Psychiatry, University of Toronto Senior Scientist, Toronto General Hospital Research Institute Specialist in Geriatric

2018 Canadian Centre on Substance Abuse

7. Pharmacologic Treatment of Hypertension in Adults Aged 60 Years or Older to Higher Versus Lower Blood Pressure Targets: A Clinical Practice Guideline from the American College of Physicians and the American Academy of Family Physicians Full Text available with Trip Pro

. et al HYVET Study Group Treatment of hypertension in patients 80 years of age or older. N Engl J Med 2008 358 1887 98 Lithell H , Hansson L , Skoog I , Elmfeldt D , Hofman A , Olofsson B . et al SCOPE Study Group The Study on Cognition and Prognosis in the Elderly (SCOPE): principal results of a randomized double-blind intervention trial. J Hypertens 2003 21 875 86 Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final results (...) Pharmacologic Treatment of Hypertension in Adults Aged 60 Years or Older to Higher Versus Lower Blood Pressure Targets: A Clinical Practice Guideline from the American College of Physicians and the American Academy of Family Physicians Pharmacologic Treatment of Hypertension in Adults | Annals of Internal Medicine | American College of Physicians '); } Sign in below to access your subscription for full content INDIVIDUAL SIGN IN | You will be directed to acponline.org to register and create

2017 American College of Physicians

8. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults

; alcohol intake; ambulatory care; antihypertensive: agents, drug, medication, therapy; beta adrenergic blockers; blood pressure: arterial, control, determination, devices, goal, high, improve, measurement, monitoring, ambulatory; calcium channel blockers; diet; diuretic agent; drug therapy; heart failure: diastolic, systolic; hypertension: white coat, masked, ambulatory, isolated ambulatory, isolated clinic, diagnosis, reverse white coat, prevention, therapy, treatment, control; intervention; lifestyle (...) . Laboratory Tests and Other Diagnostic Procedures e38 7.2. Cardiovascular Target Organ Damage e38 8. Treatment of High BP e39 8.1. Pharmacological Treatment e39 8.1.1. Initiation of Pharmacological BP Treatment in the Context of Overall CVD Risk e39 8.1.2. BP Treatment Threshold and the Use of CVD Risk Estimation to Guide Drug Treatment of Hypertension e40 8.1.3. Follow-Up After Initial BP Evaluation e42 8.1.4. General Principles of Drug Therapy e42 8.1.5. BP Goal for Patients With Hypertension e43 8.1.6

2017 American Heart Association

9. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary Full Text available with Trip Pro

relevant to this guideline, was conducted between February and August 2015. Key search words included but were not limited to the following: adherence; aerobic; alcohol intake; ambulatory care; antihypertensive: agents, drug, medication, therapy; beta adrenergic blockers; blood pressure: arterial, control, determination, devices, goal, high, improve, measurement, monitoring, ambulatory; calcium channel blockers; diet; diuretic agent; drug therapy; heart failure: diastolic, systolic; hypertension: white (...) Treatment of Hypertension 1286 8.1.3. Follow-Up After Initial BP Evaluation 1287 8.1.4. General Principles of Drug Therapy 1288 8.1.5. BP Goal for Patients With Hypertension 1290 8.1.6. Choice of Initial Medication 1290 8.2. Follow-Up of BP During Antihypertensive Drug Therapy 1290 8.2.1. Follow-Up After Initiating Antihypertensive Drug Therapy 1290 8.2.2. Monitoring Strategies to Improve Control of BP in Patients on Drug Therapy for High BP 1291 9. Hypertension in Patients With Comorbidities 1291 9.1

2017 American Heart Association

10. Interventions to Prevent Age-Related Cognitive Decline, Mild Cognitive Impairment, and Clinical Alzheimer's-Type Dementia

difficulty learning new information by 70 or 80 years old may not necessarily be a warning sign of neurocognitive disease in the absence of other signs or symptoms of cognitive difficulty. This type of normal cognitive aging is called age-related cognitive decline and is highly variable between individuals. 7 The relationship between age-related cognitive decline and dementia is unclear. If the magnitude of cognitive decline exceeds a threshold (variously defined), the individual is said to have (...) studies used multidomain interventions, and potentially none have explored the possibility of cumulative or synergistic effects. Timing and measurement choices affect cognitive decline prevention studies. Researchers can recruit participants at any point along the cognitive continuum. Various proposed strategies target young and middle-aged adults with no evidence of cognitive decline, older adults worried about age-related changes, people with documented MCI, and those with major neurocognitive

2017 Effective Health Care Program (AHRQ)

11. Interventions to Prevent Age-Related Cognitive Decline, Mild Cognitive Impairment, and Clinical Alzheimer's-Type Dementia

difficulty learning new information by 70 or 80 years old may not necessarily be a warning sign of neurocognitive disease in the absence of other signs or symptoms of cognitive difficulty. This type of normal cognitive aging is called age-related cognitive decline and is highly variable between individuals. 7 The relationship between age-related cognitive decline and dementia is unclear. If the magnitude of cognitive decline exceeds a threshold (variously defined), the individual is said to have (...) studies used multidomain interventions, and potentially none have explored the possibility of cumulative or synergistic effects. Timing and measurement choices affect cognitive decline prevention studies. Researchers can recruit participants at any point along the cognitive continuum. Various proposed strategies target young and middle-aged adults with no evidence of cognitive decline, older adults worried about age-related changes, people with documented MCI, and those with major neurocognitive

2017 Effective Health Care Program (AHRQ)

12. The effect of SENATOR (Software ENgine for the Assessment and optimisation of drug and non-drug Therapy in Older peRsons) on incident adverse drug reactions (ADRs) in an older hospital cohort - Trial Protocol. Full Text available with Trip Pro

The effect of SENATOR (Software ENgine for the Assessment and optimisation of drug and non-drug Therapy in Older peRsons) on incident adverse drug reactions (ADRs) in an older hospital cohort - Trial Protocol. The aim of this trial is to evaluate the effect of SENATOR software on incident, adverse drug reactions (ADRs) in older, multimorbid, hospitalized patients. The SENATOR software produces a report designed to optimize older patients' current prescriptions by applying the published STOPP (...) and START criteria, highlighting drug-drug and drug-disease interactions and providing non-pharmacological recommendations aimed at reducing the risk of incident delirium.We will conduct a multinational, pragmatic, parallel arm Prospective Randomized Open-label, Blinded Endpoint (PROBE) controlled trial. Patients with acute illnesses are screened for recruitment within 48 h of arrival to hospital and enrolled if they meet the relevant entry criteria. Participants' medical history, current prescriptions

2019 BMC Geriatrics Controlled trial quality: predicted high

13. Employment Interventions for Return to Work in Working Aged Adults Following Traumatic Brain Injury (TBI): A Systematic Review Full Text available with Trip Pro

interaction of variables, including pre‐morbid factors (e.g., age, education, and prior employment history), injury‐related factors (type, severity, and location), post‐injury impairments, and personal and environment factors (e.g., marital status, alternative income sources, and social support). Because of this complexity and the unique characteristics of each individual with a TBI, prediction of RTW is not feasible. They note, however, that the literature includes numerous examples of high‐risk (...) consisted of physical fitness training, and group and individual therapies. Therapies included cognitive, psychotherapy, pragmatic speech, community re‐entry, and integrated work programs. The 53 active duty military participants assigned to the in‐home without VR intervention treatment group received a limited home rehabilitation program. Their mean age was 26, 96% were male, 70% were White, 17% were African American, 11% were Hispanic, and 2% were Native American. All had moderate to severe TBI

2016 Campbell Collaboration

14. An update to the Greig Health Record: Preventive health care visits for children and adolescents aged 6 to 17 years ? Technical report

for sexual activity In Canada, the criminal code defines the age of consent for sexual activity as 16 years for non-exploitative activity and as 18 years for situations involving prostitution, pornography or in relationships where there is a difference in authority or dependence. There are close-in-age exceptions. For 14- or 15- year-olds, the relationship must be non-exploitative and the partner must be < 5 years older. For 12- and 13-year-olds, the partner must be < 2 years older. For details, see (...) the strength of the recommendation. The checklist tables are divided arbitrarily into early, middle and late age groupings, but it is important to remember that children develop at different rates and screening questions should be tailored to each individual. For example, it may be appropriate to discuss pubertal development with some 8- or 9- year-olds, especially girls, but not appropriate for their less mature peers. A small area for family history is included on the top left-hand corner of each

2016 Canadian Paediatric Society

15. Sialanar (glycopyrronium) - for treating severe drooling of saliva in children and adolescents (aged 3 years and above) with conditions affecting the nervous system, such as cerebral palsy, epilepsy and neurodegenerative diseases

mg/ kg/day. Nevertheless, clinical data showed that in children from the age of 5 years and adult patients, up to 500 mg/kg/day of propylene glycol could generally be considered safe. In the absence of compelling data this safety threshold was decreased to 50 mg/kg/day in children less than 5 years old as indicated in in CHMP assessment on propylene glycol (EMA/175205/2014). The exposure in this product is equivalent to 0.865 mg/kg/day as defined by the applicant; this is well below the set (...) effects resulted in discontinuation of treatment in 11 (28%). Overall, 26 (65%) continued to receive drug therapy because of the perceived benefit. The final effective dose ranged widely from 0.01 to 0.82 mg/kg per day. Arbouw et al 2010. Study title: Glycopyrrolate for sialorrhoea in Parkinson disease. A randomized, double-blind, crossover trial Background: Sialorrhoea affects approximately 75% of patients with Parkinson disease (PD). Sialorrhoea is often treated with anticholinergics, but central

2016 European Medicines Agency - EPARs

16. Evaluation of Potential Drug-Drug Interactions with Medications Prescribed to Geriatric Patients in a Tertiary Care Hospital Full Text available with Trip Pro

Evaluation of Potential Drug-Drug Interactions with Medications Prescribed to Geriatric Patients in a Tertiary Care Hospital The drugs most commonly implicated in major potential interactions are those used in the day-to-day clinical management of elderly patients with chronic diseases. This study is planned to evaluate the profile of drug-drug interactions in the medications prescribed to elderly population and also to identify the possible predictors for potential drug-drug interactions (...) 3.02% of drug interactions belonged to risk category X, i.e., to be avoided. Logistic regression analysis showed that age above 70 years was associated with the presence of drug interactions. Increased number of medication was independently associated with the occurrence of drug interactions. The presence of drug interactions was not associated with increased number of comorbidities.A significant number of potential drug-drug interactions were seen in the prescriptions of elderly patients

2018 Journal of aging research

17. Impact of Drug Treatment at Neonatal Ages on Variability of Drug Metabolism and Drug-drug Interactions in Adult Life Full Text available with Trip Pro

Impact of Drug Treatment at Neonatal Ages on Variability of Drug Metabolism and Drug-drug Interactions in Adult Life As the number of patients taking more than one medication concurrently continues to increase, predicting and preventing drug-drug interactions (DDIs) is now more important than ever. Administration of one drug can cause changes in the expression and activity of drug metabolizing enzymes (DMEs) and alter the efficacy or toxicity of other medications that are substrates (...) for these enzymes, resulting in a DDI. In today's medical practice, potential DDIs are evaluated based on the current medications a patient is taking with little regard to drugs the patient has been exposed to in the past. The purpose of this review is to discuss potential impacts of drug treatment at neonatal ages on the variability of drug metabolism and DDIs in adult life.Existing evidence from the last thirty years has shown that exposure to certain xenobiotics during neonatal life has the potential

2017 Current Pharmacology Reports

18. Fluoxetine and Risk of Bleeding in Patients Aged 60 Years and Older Using the Korea Adverse Event Reporting System Database: A Case/Noncase Study. (Abstract)

Fluoxetine and Risk of Bleeding in Patients Aged 60 Years and Older Using the Korea Adverse Event Reporting System Database: A Case/Noncase Study. Depression, the leading cause of nonfatal disease burden, has a strong correlation with suicide and affects approximately 7% of the general elderly population. Adverse drug reactions in older patients are particularly important because of reduced drug metabolism, polypharmacy, drug-drug interactions, and drug-disease interactions. Fluoxetine (...) is the first representative selective serotonin reuptake inhibitor but is associated with the possibility of hemorrhage based on its mechanism of action. Serious cases of gastrointestinal bleeding and cerebral hemorrhage have been reported, raising concerns about the safety of this drug.We detected signals of bleeding risk associated with fluoxetine in an elderly population using the Korea Adverse Event Reporting System database. Reporting odds ratios and 95% confidence intervals (CIs) were calculated.A

2019 Journal of Clinical Psychopharmacology

19. Pentoxifylline, dexamethasone and azithromycin demonstrate distinct age-dependent and synergistic inhibition of TLR- and inflammasome-mediated cytokine production in human newborn and adult blood in vitro. Full Text available with Trip Pro

Pentoxifylline, dexamethasone and azithromycin demonstrate distinct age-dependent and synergistic inhibition of TLR- and inflammasome-mediated cytokine production in human newborn and adult blood in vitro. Neonatal inflammation, mediated in part through Toll-like receptor (TLR) and inflammasome signaling, contributes to adverse outcomes including organ injury. Pentoxifylline (PTX), a phosphodiesterase inhibitor which potently suppresses cytokine production in newborn cord blood, is a candidate (...) ), R848 (TLR7/8 agonist) or LPS/adenosine triphosphate (ATP) (inflammasome induction). Supernatant and intracellular cytokines, signaling molecules and mRNA were measured by multiplex assay, flow cytometry and real-time PCR. Drug interactions were assessed based on Loewe's additivity.PTX, DEX and AZI inhibited TLR- and/or inflammasome-mediated cytokine production in newborn and adult blood, whether added before, simultaneously or after TLR stimulation. PTX preferentially inhibited pro-inflammatory

2018 PLoS ONE

20. Age and the anaesthetist

1000 live births – the lowest rate on record. This compares with 11.1 deaths in 1981, a 62% decrease. In the last 15–20 years, there has however, been a marked change in society’s demographics that has been due to the increasing numbers of adults surviving into old age, i.e. a genuine increase in life expectancy based on longevity rather than improvements in child and maternal health. Data from the UK’s 2011 Census [5] showed that in England and Wales, 1 in 6 of the population was aged > 65 years (...) , whereas only 1 in 16 of the population was aged 70-years-old. Less than 10% of the population lived to benefit. In Britain at the beginning of the 20th century, the only general support for old age was the Poor Law. None but a small number of people received a proper pension or had made private insurance provision. The consequent extent of poverty in the elderly resulted in Lloyd George’s Old Age Pensions Act (1908) [9], which paid a non- contributory, means-tested pension to each person aged over 70

2016 Association of Anaesthetists of GB and Ireland

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