THERAPEUTIC DRUG MONITORING IN THE ELDERLY Increase prevalence of disease = Increase in the
OBJECTIVES:
Define the geriatric age group and aging process
Determine why drug monitoring is important
Enumerate some basic parameters in drug
monitoring for commonly used medication
THE GERIATRIC AGE GROUP
65 years old and above
14.5% of the US Population (2014)
Increase to 21.7% by 2040
4.38% of the Philippine Population (2016)
DEFINITION
PHARMACOKINETICS
The study of the movement of drug in the
body, including the process of absorption,
distributor, localization in the tissues,
biotransformation and excreation
PHARMACODYNAMICS
The study of the biochemical and
physiological effects of drugs and the
mechanisms of their actions, including the
correlation of their actions and effects with
their chemical structure
THE AGING PROCESS
COMPLEX PROCESS
Progressive loss in the functional capacities of
organs
Especially those involved in drug diposition
Reduction in mechanism of homeostasis
Altered response to receptor stimulation
IS THERE A NEED TO MONITOR?
Physiological effect of aging combine to:
Increase susceptibility of elderly to
environmental and physical stressors
Increase the effects of medication FUROSEMIDE
Increase vulnerability to morbidity and
mortality
use of medication
Medication Therapy
Widely used and higly valuable intervention
One of the most difficult aspects of patient
care in the elderly
FACTORS
-Large numbers of drugs
- Drug Interaction
- Higher incidence of adverse drug reaction
- Increased sensitivity of target organs
- Impaired physiologic control system
- Difficult optimization of drug therapy
- Variability of drug response
HOW DO WE MANAGE?
Optimize Drug Therapy
-Determine drug medication
- Choose the best drug
- Determine the dose and schedule
appropriate for the patients physiologic
status
- Educate the patient and care givers
about the expected side effects and
indication when to seek consult
- Monitor effectiveness, toxicity, and
reactions
MONITORING
Clinical beneficial response
Harmful effects
Clinically
Based on laboratory parameters
THIAZIDES
Inhibits Na transport in the distal tubule
Increase reabsorption of calcium
EFFECT: -Hyponatremia
-Hypercalcemia
Compete for the chloride position diminishing net
reabsorption of Na and K
 EFFECT: - Hyponatremia Anti-platelet, analgesic, antipyretic, anti-
Hypokalemia inflammatory

DIURETICS ANTIBIOTICS
Decrease urates excretion by increase net urates Penicillin, Cephalosporins, Fluoroquinolones,
reabsorption Aminoglycosides
Dose dependent Metabolism is primarily in the kidneys
EFFECT: - Hyperuricemia EFFECTS: May aggrevate existing kidney
-Acute Kidney Injury from Dehydration disease
MONITOR: - UA, BUN, CREATININE MONITOR: BUN, CREA, Creatinine Clearance

WARFARIN INSULIN
Vitamin K Antagonist Insulin is a protein chain or peptide hormone
-Blocks Vitamin K dependent factors Insulin is produced in the islets of Langerhans
Narrow therapeutic range in the pancreas
EFFECTS: - Risk of bleeding, Nepropathy Allows glucose utilization by the tissues
MONITOR: -PT/INR, BUN/CREATININE/Liver EFFECTS: Hypoglycemia
Function Tesr MONITOR: CBG

AMIODARONE ANTI-TB DRUGS

Class III anti- arrhythmic drug Isoniazid, Rifampin, Pyrazinamide
Effects on thyroid function due to its high Streptomycin
iodine content -Nephrotoxicity and electrolyte
Direct toxic effects on the thyroid follicular cells abnormalities
(Destructive thyroiditis) Pyrazinamide
Decrease T3 production -Pyrazinoic Acid competes with uric acid
Decrease expression of thyroid hormone- elimination via kidneys
related genes - Hyperuricemia
EFFECTS: MONITOR: Liver Function Test, BUN, CREA,
-Hypothyroidism/Hyperthyroidism UA
MONITOR: Thyroid Function Test
HERBAL MEDICATIONS
DIGOXIN Perceived as natural, promotes healing and
Cardiac glycoside is always safe
Positive inotropic, neurohormonal and There are potential side effects
electrophysiological actions -Hypogylcemia, hyperglycemia,
Elimination via the urine (unchanged) nephrotoxicity
EFFECT: -Risk for toxicity - May have harmful contaminant heavy
-Aggravate arrhythmia associated electrolyte metals
imbalance (K and Mg) Herb-Drug Interactions
MONITOR: Digoxin Assays, Serum K, Mg -Ginkgo biloba has antiplatelet and
antithrombotic effects
-Interact with warfarin, NSAIDs, Aspirin
ASPIRIN
An acetylated salicylate (ASA) Grapefruit juice may elevate plasma concentration
NSAID of calcium channel blockers
 (Felodipine, Nifedipine, Amlodipine)
-Risk for Hypotension
With therapeutic promise
Ginger antiemetic efficacy
Probiotics for various GI conditions
Ulcerative colitis, infectious diarrhea, irritable
bowel syndrome
Fish oils-contain omega 3-fatty acids, DHA may
promote reduction in cardiovascular risk
Majority do not fall into either the recommended or
discourage category
-Uncertain , insufficient, or contradictory evidence
regarding quality, efficacy, safety
Monitor both benefits and adverse effects.
Caution in older adult due to possible decreased
renal and hepatic clearance of herb and drug
metabolites.
Greater potential for her-drug interactions

SUMMARY
Physiologic changes in the elderly affect
the drugs pharmacodynamics ang
pharmacokinetics
Medication therapy is highly valuable
We need to monitor not only the beneficial
effect but the possible adverse effect as
well
Even herbal medications and supplements
have potential harmful effect if
unmonitered