Prescribing for Elderly Patients

, by Jackson, Stephen; Jansen, Paul; Mangoni, Arduino

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ISBN: 9780470024287 | 0470024283
Cover: Hardcover
Copyright: 6/29/2009

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A guide for doctors to quickly choose the right drugs in the right dose for the most important clinical problems in the elderly Prescribing medications for elderly patients is complex - this book gives clear advice on treatment regimes, drug interactions, adverse effects, and recommended dose changes Provides practical help with the problems that can arise in reaching an accurate diagnosis in the elderly, recommends clear treatment options, lists key drug interactions and side effects, and advises when to amend doses

List of Contributors
Foreword
Preface
Acknowledgement
Clinical Pharmacology of Ageing
Epidemiology
Age-related changes in pharmacokinetics
Age-related changes in pharmacodynamics
Adverse drug reactions and drug interactions
Adherence
Polypharmacy versus appropriate prescribing
Over-the-counter medicines
Prescribing audit
Medication review
Undertreatment
References
Dementia, Delirium, Agitation and Behavioural Problems
Dementia
Delirium
Agitation and behavioural problems
References
Depression in Elderly Patients
Introduction
Aetiology
Signs and symptoms
Diagnosis
Therapy
References
Psychotic Illness in Elderly Patients
Introduction
Aetiology
Symptoms and signs
Diagnosis
Therapy
Key points
References
Sleep Disorders in the Elderly: the Pros and Cons of Prescribing
Insomnia
Restless legs syndrome and periodic limb movements of sleep
Nocturnal leg cramps
REM behaviour disorder
References
Stroke
Introduction
Aetiology
Modifiable risk factors for stroke
Therapy
Key points
References
Orthostatic Hypotension, Postprandial Hypotension and Syncope in Older Patients
Orthostatic hypotension in older patients
Key points
Postprandial hypotension in older patients
Key points
Syncope in older patients
Key points
Guidelines
References
Parkinso's Disease
Introduction
Symptoms and signs of PD
Aetiology and pathology
Diagnosis
Therapy
Key points
Links
References
Epilepsy
Introduction
Aetiology
Symptoms and signs
Diagnosis
Therapy
Newer anti-epileptic drugs
Safety of anti-epileptic drugs
Therapy scheme of the advised drugs
Clinically-important drug interactions within anti-epileptic drugs
Clinically-important drug interactions with other drugs
Important adverse effects
Drug withdrawal
Key points
References
Hypertension
Introduction
Aetiology
Symptoms and signs
Diagnosis
Investigation
Therapy
Clinical pharmacology of antihypertensive therapy
Key points
Links
References
Lipid-Lowering in the Elderly Patient
Introduction
Aetiology
Symptoms and signs
Diagnosis
Therapy
Statins
Fibrates
Nicotinic acid
Ezetimibe
Bile acid sequestrants
Omega-3 fatty acids
Guidelines
Key points
Links
References
Acute Coronary Syndrome
Introduction
Aetiology
Symptoms and signs
Diagnosis
Therapy
Therapy scheme of the advised drugs
Key points
Guidelines
Acknowledgements
References
Heart Failure
Introduction
Epidemiology
Aetiology
Clinical presentation
Diagnosis
Therapy
Key points
Guidelines
Acknowledgements
References
Atrial Fibrillation and Other Rhythm Disturbances in the Elderly
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
Valvular Heart Disease
Introduction
Infective endocarditis
Prevention of endocarditis
Diagnosis and treatment of endocarditis
Prevention of thromboembolism
Prevention of progression of degenerative valvular disease
References
Anticoagulants for Thrombosis and Embolism in the Elderly
Introduction
The anticoagulants
Thrombosis in the elderly and indications for anticoagulants
References
Haematological Disorders
Introduction
Anaemia
Vitamin B12 and folic acid deficiencies
Thrombocytopenia
Myelodysplastic syndromes
Acute leukaemia
Lymphoproliferative conditions
Multiple myeloma
Key points
References
COPD and Asthma in the Elderly
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
Pneumonia in the Elderly
Introduction
Epidemiology
Aetiology and pathogenesis
Symptoms and signs
Diagnosis
Patient assessment
Therapy
Important considerations for drug usage
Prevention
References
Therapeutic Aspects of Pulmonary Tuberculosis
Introduction
Pathogenesis
Presentation of tuberculosis in the elderly
Diagnosis of tuberculosis
Treatment of tuberculosis
Treatment of latent tuberculosis infection
Key points
References
Interstitial Lung Disease in the Elderly
Introduction
Presentation of interstitial lung disease
Particular problems in the elderly
General comments with regard to therapy
Assessing the response to therapy
Drugs used in ILD
Treatment for specific forms of lung disease
Key points
Links
References
Lung Cancer in the Elderly
Introduction
Aetiology
Symptoms and signs
Diagnosis and staging
Goals of therapy
Chemotherapeutic agents
Treatment protocols for NSCLC
Non cytotoxic agents: EGFR Inhibitors
Treatment of small cell carcinoma
Treatment of mesothelioma
Anti-emetic therapy
Key Points
Guidelines
References
Nutritional Disorders and the Older Person
Introduction
Obesity and the older person
Nutritional frailty
Under-nutrition in older people
Screening and assessment of under-nutrition
The management of the under-nourished older person
Monitoring and change
Conclusion
References
Mouth and Dental Disorders
Introduction
Periodontal disease
Dental caries
Odontogenic infections
Alveolar osteitis
Xerostomia and hyposalivation
Candidiasis
Angular cheilitis
Denture stomatitis
Burning mouth syndrome
Recurrent aphthous stomatitis
Recurrent herpes simplex
Oral lichen planus
Swallowing Disorders and Medication in the Elderly
Introduction
Normal deglutition
Changes with Age
Aetiology of deglutition disorders
Symptoms and signs
Diagnosis
Therapy
Deglutition disorders and medication
Key points
Links
References
Upper Gastrointestinal Disorders
Gastrooesophageal reflux disease
Oesophageal motility disorders
Non-cardiac chest pain
Oesophageal infections
Pill-induced oesophagitis
Peptic ulcer disease
Gastritis
Non-ulcer dyspepsia
References
Gastric Emptying in Older Patients
Introduction
Aetiology of disturbed gastric motor function in ageing
Symptoms and signs
Diagnosis
Therapy
Therapy scheme of advised drugs for gastroparesis
Key points
Guidelines
Effect of healthy ageing on appetite regulation anorexia of ageing
References
Lower Gastrointestinal Disorders
Malabsorption
Inflammatory bowel disease
Diverticulosis
Mesenteric ischaemia
Constipation
Diarrhoea and faecal incontinence
Haemorrhoids
References
Abdominal Malignancies
Introduction
Epidemiology
Aetiology
Symptoms and signs
Therapy
Chemotherapy
Key points
Links
References
Liver Diseases in the Elderly R&ymacron;me Mountfield
Introduction
Physiological changes associated with ageing
Drug induced liver disease
Cirrhosis
Alcoholic liver disease
Non-alcoholic steatohepatitis (NASH)
Hepatitis C
Hepatitis B
Liver transplantation
References
Disorders of the lower urinary tract
Pathophysiology
Incontinence subtypes
Treatment cessation
Assessment with a bearing on drug addition or withdrawal
Rectal examination
Vaginal examination
The pharmacological treatment of urinary incontinence
Cognition and antimuscarincs
Bladder outflow tract obstruction
Other pharmacological measures
Stress urinary incontinence
Summary
References
Management of Benign Prostatic Hyperplasia in Elderly Men
Assessment
Prostate specific antigen (PSA)
Urinary retention
Nocturnal frequency
Treatment
References
Management of Erectile Dysfunction in the Elderly
Introduction
Prevalence and aetiology of ED
Physical or psychogenic?
Diagnosis and assessment of ed in primary care
Treatment options
Key points
References
Benign Gynaecological Disorders
Urogenital atrophy
Prolapse
Traditional anatomical site prolapse classification
Urinary incontinence
Detrusor overactivity
Drug therapies
Lichen sclerosis
Lichen planus
References
Breast Cancer in Elderly Patients
Introduction
Presentation and diagnosis special considerations in elderly patients
Management of breast cancer
Management of early breast cancer
Treatment of advanced breast cancer
Supportive care during breast cancer treatment
Breast cancer therapeutics in an elderly patient
Conclusion
Key points
References
Pharmacological Management of Endocrine Conditions in the Elderly Patient
Introduction
Diabetes aetiology
Diabetes symptoms and signs
Diabetes diagnosis
Type 2 diabetes management
Pharmacokinetic and pharmacodynamic data of diabetes medications in elderly patients
Clinically important drug interactions within diabetes drugs
General adverse effects of diabetes medications in elderly patients
Specific adverse effects and clinically-important drug interactions of diabetes drugs
Pituitary adenomas
Thyroid disease
Hyperparathyroidism
Hormone replacement
Endocrine disease in the elderly key points
Further Reading
Rheumatoid Arthritis, Osteoarthritis, Polymyalgia Rheumatica, Gout and Pseudogout
Rheumatoid arthritis
Key points in rheumatoid arthritis
Osteoarthritis
Key points in osteoarthritis
Polymyalgia rheumatica
Key points in PMR
Gout and calcium pyrophosphate disease (CPPD)
Key points in gout and CPPD
Links
References
Falls, Osteoporosis, Page's Disease and Osteomalacia
Falls and osteoporosis
Page's disease
Osteomalacia
Key points
References
Drugs and Falls
Introduction
Pathophysiology
Fall-risk-increasing drugs
Clinical approach
Treatment: drug withdrawal
Key points
References
Pressure Ulcers
Introduction
The role of pressure in pressure ulcer development
The role of nutrition in pressure ulcer development
Risk assessment
Prevention
Local treatment
Key points
References
Leg Ulceration
Introduction
Aetiology
Symptoms and signs
Diagnosis
Therapy
Key points
Guidelines
References
Xerosis and Asteatotic Eczema
Xerosis
Actinic keratoses and Bowe's disease
Bullous pemphigoid
Candidiasis
Erysipelas and cellulitis
Contact dermatitis
Herpes zoster (shingles)
Lichen planus
Malignant melanoma
Mycosis fungoides
Basal cell carcinoma and squamous cell carcinoma
Psoriasis
Scabies
Tinea
Urticaria and angio-oedema
Venous eczema and the dependency syndrome
Age-Related Eye Diseases
Cataract
Glaucoma
Age related macular degeneration
Diabetic retinopathy
References
Ear Disorders
Introduction
Hearing loss
Tinnitus
External otitis
Drugs causing hearing problems
References
Pain
Introduction
Aetiology
Diagnosis
Therapy
Key points
References
Palliative Care in the Elderly
Introduction
Symptoms
Palliative care in the elderly
Treatment of common symptoms in elderly patients
References
Index
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Prescribing for Elderly Patients

Summary

Author Biography

Table of Contents

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