Unit 8 Geriatrics.pdf related to pharmacy

It is related to pharmacology topic of dementia

1. Unit 8
Geriatrics

5. Principles of Rational Prescribing in Elderly
1.Start Low, Go Slow
Initiate therapy at lower doses; titrate gradually.
2.Regular Review
Periodically assess need for continued therapy.
3.Avoid High-Risk Drugs
Use Beers Criteria as guidance.
4.Monitor Therapy
Check renal/hepatic function, electrolytes, and therapeutic drug levels.
5.Simplify Regimen
Reduce polypharmacy and dosing frequency for adherence.

8. Dementia is a syndrome in which there is an impairment of brain functions (memory
loss and judgment), which affects or interferes with individuals' ability with daily
functioning.
Dementia is characterized into two major categories: 1) neurodegenerative
(formerly known as irreversible); 2) non-neurodegenerative (potentially reversible)

17. Posturalhypotension(alsoknownasorthostatichypotension)isaconditioncharacterized
byasignificantdropinbloodpressurewhenapersonmovesfromlyingdownorsittingto
standingup.Specifically,itisdefinedasadecreaseinsystolicbloodpressureofatleast20
mmHgordiastolicbloodpressureofatleast10mmHgwithin3minutesofstanding.
Introduction to Postural
Hypotension

18. CausesofPosturalHypotension
1.Dehydration:Lackofadequatefluidsreducesbloodvolume,whichleadstoadropin
bloodpressure.
2.HeartProblems:Conditionslikebradycardia,heartvalveissues,orheartfailurecan
impairtheabilityofthehearttopumpbloodeffectively.
3.EndocrineDisorders:Diabetes,adrenalinsufficiency,andthyroidconditionscanaffect
thebody'sabilitytoregulatebloodpressure.
4.Medications:Certaindrugssuchasdiuretics,antihypertensives,antidepressants,and
vasodilatorscancauseposturalhypotensionbyloweringbloodpressureorreducingblood
volume.
5.NervousSystemDisorders:DiseaseslikeParkinson’sdisease,multiplesystematrophy,
andautonomicneuropathycandamagethenervesthatcontrolbloodpressureregulation.
6.ProlongedBedRest:Beingbedriddenforextendedperiodsweakensthecardiovascular
system,makingitdifficulttoadjusttostanding.
7.Aging:Age-relatedchangesinbloodvesselelasticityandthebody'sabilitytoquickly
adjustbloodpressurewhenchangingpositioncancontributetoposturalhypotensioninthe
elderly.

19. SymptomsofPosturalHypotension
Dizzinessorlightheadednessuponstanding
Blurredortunnelvision
Weaknessorfatigue
Fainting(syncope)
Confusion(especiallyinolderadults)
Nausea
Diagnosis of Postural Hypotension
Diagnosisofposturalhypotensioninvolvesevaluatingbloodpressurechangeswhenmovingfroma
supine(lyingdown)positiontostanding.Theprocessincludes:
1.BloodPressureMeasurement
2.BloodTests
3.ECGandEchocardiogram
4.AutonomicFunctionTesting

20. Management of Postural Hypotension

21. Non-PharmacologicalManagement
LifestyleModifications:
oGradualPositionChanges
oElevatingtheHeadoftheBed
oIncreasedSaltIntake:Exercise
2.PharmacologicalManagement
Fludrocortisone:
oAmineralocorticoidthathelpsincreasebloodvolumebypromotingsodiumretentioninthekidneys.Thisisoftenusedwhen
lifestylechangesareinsufficient.
oSideEffects:Hypokalemia(lowpotassium),fluidretention,andhighbloodpressureinotherpositions.
Midodrine:
oAvasopressorthatworksbyconstrictingbloodvessels,therebyincreasingbloodpressurewhenstanding.
oSideEffects:Tinglingsensations,goosebumps,andsupinehypertension(highbloodpressurewhenlyingdown).
Pyridostigmine:
oUsedincasesofneurogenicorthostatichypotension,thismedicationenhancestheactivityoftheparasympatheticnervoussystem,
improvingbloodpressureregulation.
oSideEffects:Diarrhea,nausea,andabdominalcramps.
Droxidopa:
oSpecificallyusedforneurogenicorthostatichypotension,itincreasesthelevelsofnorepinephrine,whichhelpsimprovevascular
toneandbloodpressureuponstanding.
Treatment of Postural Hypotension

22. Outcomes
•Understand age-related changes in drug absorption,
distribution, metabolism, and excretion.
•Identify drugs with high risk of adverse effects in the
elderly.
•Recognize polypharmacy and drug-drug interactions.
•Identify drugs causing cognitive impairment or drug-
induced dementia.
•Understand mechanisms and prevention of postural
hypotension.
•Adjust drug doses based on renal and hepatic function.
•Counsel elderly patients on safe medication use and
monitoring.