Prescribing for Elderly Patients

Prescribing for elderly patients is complex and challenging. There is a higher incidence of co–morbidities, and an increased likelihood that the patient will already be on other medication. There are also complex drug interactions that need to be monitored, and an increased risk of adverse effects due to differences in drug distribution and clearance.
This book is specifically designed to provide comprehensive information to assist health care professionals in diagnosing and managing common geriatric conditions effectively and safely. Age–related changes in pharmacokinetics are clearly illustrated in tabular format, and treatment algorithms are derived from a thorough evidence–based review of the literature and the latest guidelines.
Each chapter
provides practical information on the problems that can arise in reaching an accurate diagnosis in elderly patients
recommends clear treatment options
lists key drug interactions and side effects, and advises when to amend doses
contains key references and a list of selected websites linked to professional national and international organisations and guideline groups
Prescribing for Elderly Patients is invaluable for consultants in geriatric medicine, specialist registrars and other trainees, general physicians (internists), clinical pharmacologists, and any clinicians working regularly with elderly patients. It is also useful as a quick reference guide for nurses and clinical pharmacists.


Spis treści:
List of Contributors.
Foreword.
Preface.
Acknowledgement.
1 Clinical Pharmacology of Ageing (Arduino Mangoni, Paul Jansen and Stephen Jackson).
Epidemiology.
Age–related changes in pharmacokinetics.
Age–related changes in pharmacodynamics.
Adverse drug reactions and drug interactions.
Adherence.
Polypharmacy versus appropriate prescribing.
Over& #8211;the–counter medicines.
Prescribing audit.
Medication review.
Undertreatment.
References.
2 Dementia, Delirium, Agitation and Behavioural Problems (Catherine Bryant).
Dementia.
Delirium.
Agitation and behavioural problems.
References.
3 Depression in Elderly Patients (Richard Weeks, Ross Kalucy and Jo Hill).
Introduction.
Aetiology.
Signs and symptoms.
Diagnosis.
Therapy.
References.
4 Psychotic Illness in Elderly Patients (Ross Kalucy, Jo Hill and Richard Weeks).
Introduction.
Aetiology.
Symptoms and signs.
Diagnosis.
Therapy.
Key points.
References.
5 Sleep Disorders in the Elderly: the Pros and Cons of Prescribing (R. Doug McEvoy and Karin S. Nyfort–Hansen).
Insomnia.
Restless legs syndrome and periodic limb movements of sleep.
Nocturnal leg cramps.
REM behaviour disorder.
References.
6 Stroke (Joseph A. Harbison and Gary A. Ford).
Introduction.
Aetiology.
Modifiable risk factors for stroke.
Therapy.
Key points.
References.
7 Orthostatic Hypotension, Postprandial Hypotension and Syncope in Older Patients (René W.M.M. Jansen).
Orthostatic hypotension in older patients.
Key points.
Postprandial hypotension in older patients.
Key points.
Syncope in older patients.
Key points.
Guidelines.
References.
8 Parkinson’s Disease (Gerrit Tissingh and Erik Ch. Wolters).
Introduction.
Symptoms and signs of PD.
Aetiology and pathology.
Diagnosis.
Therapy.
Key points.
Links.
References.
9 Epilepsy (John O. Willoughby, Joseph Frasca and Emma M. Whitham).
Introduction.
Aetiology.
Symptoms and signs.
Diagnosis.
Therapy.
Newer anti–epileptic drugs.
Safety of anti–epileptic drugs.
Therapy scheme of the advised drugs.
Clinically–importan t drug interactions within anti–epileptic drugs.
Clinically–important drug interactions with other drugs.
Important adverse effects.
Drug withdrawal.
Key points.
References.
10 Hypertension (Sanjeev Khindri and Stephen Jackson).
Introduction.
Aetiology.
Symptoms and signs.
Diagnosis.
Investigation.
Therapy.
Clinical pharmacology of antihypertensive therapy.
Key points.
Links.
References.
11 Lipid–Lowering in the Elderly Patient (Anthony S. Wierzbicki).
Introduction.
Aetiology.
Symptoms and signs.
Diagnosis.
Therapy.
Statins.
Fibrates.
Nicotinic acid.
Ezetimibe.
Bile acid sequestrants.
Omega–3 fatty acids.
Guidelines.
Key points.
Links.
References.
12 Acute Coronary Syndrome (Derek Yiu and Arduino Mangoni).
Introduction.
Aetiology.
Symptoms and signs.
Diagnosis.
Therapy.
Therapy scheme of the advised drugs.
Key points.
Guidelines.
Acknowledgements.
References.
13 Heart Failure (Arduino Mangoni).
Introduction.
Epidemiology.
Aetiology.
Clinical presentation.
Diagnosis.
Therapy.
Key points.
Guidelines.
Acknowledgements.
References.
14 Atrial Fibrillation and Other Rhythm Disturbances in the Elderly (Abhay Bajpai, Irina Savelieva and A. John Camm).
Introduction.
Atrial arrhythmias.
The epidemiology and cost of AF.
The mechanism of atrial tachyarrhythmias.
Symptoms and signs.
Diagnosis.
Classification of AF.
Causes of AF.
Principles of management of AF.
Treatment of acute onset AF.
Suppression of paroxysms of AF.
Strategies in persistent AF—rate versus rhythm control.
Rate control in permanent AF.
Risk of stroke and antithrombotic therapy in AF.
Non–pharmacological techniques to prevent thrombus formation.
Key points.
References.
15 Valvular Heart D isease (Andrew T. Elder).
Introduction.
Infective endocarditis.
Prevention of endocarditis.
Diagnosis and treatment of endocarditis.
Prevention of thromboembolism.
Prevention of progression of degenerative valvular disease.
References.
16 Anticoagulants for Thrombosis and Embolism in the Elderly (Alexander Gallus and Dolly Daniel).
Introduction.
The anticoagulants.
Thrombosis in the elderly and indications for anticoagulants.
References.
17 Haematological Disorders (Bryone J. Kuss and Sabria Alhashami).
Introduction.
Anaemia.
Vitamin B12 and folic acid deficiencies.
Thrombocytopenia.
Myelodysplastic syndromes.
Acute leukaemia.
Lymphoproliferative conditions.
Multiple myeloma.
Key points.
References.
18 COPD and Asthma in the Elderly (Martin Connolly and Tina L. Davies)
Risk factors and triggers.
Presentation and diagnosis.
Objective tests.
Differential diagnoses.
Management of COPD and asthma.
Acute asthma.
Management of exacerbations of COPD.
Management of stable COPD.
Conclusion.
Key Points.
Learning Resources.
Guidelines.
References.
19 Pneumonia in the Elderly (Peter A. Frith and Karin S. Nyfort–Hansen).
Introduction.
Epidemiology.
Aetiology and pathogenesis.
Symptoms and signs.
Diagnosis.
Patient assessment.
Therapy.
Important considerations for drug usage.
Prevention.
References.
20 Therapeutic Aspects of Pulmonary Tuberculosis (Paul van den Brande).
Introduction.
Pathogenesis.
Presentation of tuberculosis in the elderly.
Diagnosis of tuberculosis.
Treatment of tuberculosis.
Treatment of latent tuberculosis infection.
Key points.
References.
21 Interstitial Lung Disease in the Elderly (Jeffrey Bowden).
Introduction.
Presentation of interstitial lung disease.
Particular problems in