Geriatrics
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Transcript of Geriatrics
LOGO
GERIATRICS
Alzheimer's disease and treatment
1-Most common types of dementia
A-Alzheimer,s disease B-Lewey body dementia
C-Vascular causes of dementia
D-Pick,s disease E- Common reversible cause of mental status change such as (Alcohol abuse ,thyroid ....dysfunction,vitamineB12 deficiency, etc
Treatmentcomments Pharmacologic
propertiesDosage forms
Maintenance dose
Starting dose
Cholinesterase inhibitors
Bradycardia&syncope
with all CIS.
Acetyl cholinesterase
inhibitor
5-10mg even
for dis tab
10mg/d 5mg/d Donepezil(Aricept)
===oral disintegrating
tablet
Labeled for mild-
moderate Alzheimer
mild-moderatd dementia
with Parkinson's disease
Acetyl&butylchOlinestrase
inhibitor
1.5mg,3mg,4.5,
6mg 2mg/ml
oral soln
3-6mg 2time/d 18mg patch
delivers 9.5mg/d
1.5mg 2times/d9mgpatc
h delivers4.6mg/d
Rivastigmine(Exelon)
rivastigmine patch
Prefer to take with food
A selective competitive ,reversible inhibitor of acetylcholinestrase &nicotine
4,8,12mg tabs 8,16,24mgER capsules 4mg/ml of oral solution
8-12mg 2time/day or8-24mg ER once daily
4mg2 time/day
Glanatamine&Galantamine extended release
Glutamatergic therapy
Labeled for use in pt with moderate to sever Alzheimer's disease
N-methyl-D-aspartate receptor antagonist that block glutamate transmission
5-10mg tablet,2mg/ml oral solution
10mg 2time/day
5mg once/day
Mematine
BEHAVIORAL SYMPTOMS OF DEMENTIA
A-Cholinesterase inhibitors B-Atypical antipsychotic(APS)
C-Other medication -!Valproic acid
-!!Carbamazepine
-!!!Antidepressants
URINARY INCOTINENCECommon Types Of UI,Drug-Induced cause, and treatment
COMMENTS DRUG TREAMENT DESCRIPTION &DRUG INDUCE CAUSES
TYPE OF INCONTINENCE
Ant cholinergic agents are first line therapy
Antimuscarinic/anti cholinergic agent oxybutynin ,tolterodine,trospium
Detrusor muscle instability can be cause CNS damage from stroke
Urge or overactive bladder
TCAS are not preferred for use in elder pts
TCAS such as imipramine doxepin
Drug induce cause..cholinergic agents the bladder such
bethanechol
Description Stress
incontinence
It has low efficacy in treatment UI
Not FAD approved(including
nausea` dry mouth est).
α-adrenergic agonists(pesudoehedrine,phenylephrine conjugated estrogen vaginal creamDuloxetineSerotonin/norepinephrine reuptake inhibitor
Loss of urine with increased abdominal pressure(sneezing, coughing)
Drug induced causes (α-blockers such as prazosin dec urethral sphincter tone
CON DESCRIPTION OVERFLOW IU
Adverse effects depneding on selectivity to receptors they will act
Stimulate s the detrusor muscle
α-Adrenergic antagonists (Alfuzosin,Tamsulosin,terazosin +5-hydroxy reductase inhibitor or bladder antispamodics (finasteride ,tolterodine,oxybutyninCholinomimetic as Bethanechol
Caused by obstruction
Treatment according to cause
Focus on symptoms that dominate
Description UI more than cause either stress and overactive bladder
MixedIU
Benign Prostatic Hypertrophy
Epidemiology
Usually develops after age 40,by the age 60 half of them have BPH,by age 85 ,90% have BPH
Treatment α-Adrenergic blocker which act by reducing smooth muscle contraction in the urethra
Nonspecific α-adrenergic blockers such as terazosin lower b.p
CONT
Newer agent are selective α1a adrenergic blockers as(Tamsulosin,Alfuzosin) all theα-a-blocker lower b.p
2-α-Reductase inhibitor
========Prevent the conversion of testosterone
To(DHT) dihydrotesosteone which stimulate prostate growth (e.g.) Finasteride inhibits Type II5-αredutcase and lower prostate( DHT) by 80%-90%
Duratation of therapy six months
-Combination therapy
Finasteride +tamsulosin
-Surgery
ARTHRITIS
Osteoarthritis
Women are afflicted more often than men. Large weight-bearing joints ,such as hip and knee are commonly affected GOALS OF THEPAY
-To relieve pain -Maintain or improve joint function
-prevent loss of function
No pharmacologic treatment Patients need to understand chronic of (OA) -Weight loss-Physical therapy-
,finally surgery Exercise-Drug therapy
Acetaminophen 1G/4times/day (large dose can PT,with liver disease should take 2600mg/day))liver failure
In older people with OA,NSAIDS should seldom be used
In selected PT,cyclooxygenase-2(cox-2)- inhibitors and NSAIDS may be used ,for those using nonselective
NSAIDS ,a proton pump inhibitor should be used, also in those using celecoxib and aspirin(for cardiac disease)
Opioids for persistent OA
Adjuvant drug therapy Gabapentin ,in patients with neuropathic pain ,avoid TCAS
-Avoid the used of skeletal muscle relaxants because of high risk of anti cholinergic adverse effect
-Alternative dietary supplements
a-GLUCOSAMINE SULAFATE 500mg taken 3time/day,for chronic therapy to prevent joint degradation and relive pain
RHEUMATOID ARTHRITIS
Epidemiology
1-Asystemic disease characterized by inflammatory arthritis that affects the small joint of hands ,wrists ,and feet
2-It is an autoimmune disease
Treatment
The same as AO
HANAN.N Pharmacist