High-risk drugs in the elderly population

Benzodiazepines in epilepsy: pharmacology and pharmacokinetics

Benzodiazepines (BZDs) remain important agents in the management of epilepsy. They are drugs of first choice for status epilepticus and seizures associated with post-anoxic insult and are also frequently used in the treatment of febrile, acute repetitive and alcohol withdrawal seizures. Clinical advantages of these drugs include rapid onset of action, high efficacy rates and minimal toxicity. Benzodiazepines are used in a variety of clinical situations because they have a broad spectrum of clinical activity and can be administered via several routes. Potential shortcomings of BZDs include tolerance, withdrawal symptoms, adverse events, such as cognitive impairment and sedation, and drug interactions. Benzodiazepines differ in their pharmacologic effects and pharmacokinetic profiles, which dictate how the drugs are used. Among the approximately 35 BZDs available, a select few are used for the management of seizures and epilepsy: clobazam, clonazepam, clorazepate, diazepam, lorazepam and midazolam. Among these BZDs, clorazepate has a unique profile that includes a long half-life of its active metabolite and slow onset of tolerance. Additionally, the pharmacokinetic characteristics of clorazepate (particularly the sustained-release formulation) could theoretically help minimize adverse events. However, larger, controlled studies of clorazepate are needed to further examine its role in the treatment of patients with epilepsy.

Predicting post-surgical cognitive disturbance in older Taiwanese patients

The purpose of this study was to test a theoretical model to understand the influences of six predicting variables in post-surgical cognitive disturbance in older Taiwanese patients after elective surgery. The data were collected in a medical center in Taipei, Taiwan. Ninety-three patients were included in the final analysis. The findings showed that cognitive function at admission (beta=0.50, p<0.001), physical function at admission (beta=-0.34, p<0.001), and physiological stability (beta=-0.21, p<0.01) had direct effects on post-surgical cognitive disturbance. Physical function and cognitive function at admission also affected post-surgical cognitive disturbance indirectly through physiological stability. These variables accounted for 67% of the total variance of post-surgical cognitive disturbance. The findings from this study suggest that a careful and systematic assessment of the patient's condition at the time of admission is important. It is necessary to monitor and correct these variables at admission or before surgery to prevent or reduce the impact of post-operative delirium. It is also necessary to monitor these variables during the hospital stay to help nurses to distinguish the etiology of delirium. In each case, knowing when confusion is more likely to occur can assist in focusing more appropriate and effective efforts at detection, thereby reducing the consequences associated with confusion.

A prediction model for polypharmacy: are older, educated women more susceptible to an adverse drug event?

INTRODUCTION

This study attempts to account for variation in the number of prescription medications concurrently consumed in geriatric populations.

METHODS

Data were selected from The National Health and Nutrition Examination Survey, III, 1988-1994 (NHANES III), Adult Household Questionnaire, a complex, multistage, clustered sampling of civilian, non-institutionalized populations, which included a volunteer sample of 5,249 individuals aged 65 and older who participated in NHANES III survey, representing four broad geographic regions and twelve states.

RESULTS

Age, income, and educational level accounted for nine percent of the variation in the number of prescription medications concurrently taken (p < 0.0001); though non-significant, there were gender differences regarding polypharmacy; in addition, there were significant differences with respect to educational levels by region and age by region (p < 0.05).

CONCLUSIONS

Educational level accounted for the most variation in polypharmacy. Women, on average, consumed more prescription medications than men. Older, more educated women may be most likely to engage in polypharmaceutical consumption, suggesting a greater likelihood of an adverse drug event.

Medication safety: a protocol for nursing action. NICHE Faculty

Medication consumption represents a significant source of adverse events, therapeutic misadventure, and toxicity to older Americans. Estimates indicate that as many as 25% to 40% of all U.S. prescriptions are written for older people. Hospital admission rates for drug-related problems and toxicity in elders approach 33% in some studies. This article addresses some of the physiological changes associated with aging and their effects on the absorption, distribution, and metabolic fate of common medications in elders. High-risk medications are identified, and strategies for combating their adverse effects are suggested.

Benzodiazepine-induced persisting amnestic disorder: are older adults at risk?

Currently there are approximately 31.5 million Americans 65 years and older. This number is expected to reach 39.3 million by 2010. This group represents 12% of the population, however, they use 25% to 40% of the prescription medications, averaging 4.5 medications daily; 75% of them use over-the-counter medications as well. This population has also experienced an increase in the prescription of central nervous system (CNS) medications. Benzodiazepines are the most widely prescribed class of CNS antianxiety/sedative medication. This article examines the use of benzodiazepines in relation to physiological, pharmacokintic, and pharmacodynamic changes of the older adult. The amnestic properties of these drugs in relation to the already decreasing cognitive function of the older adult are explored in relationship to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, criteria for substance-induced persisting amnestic disorder.