Clinical Pharmacology. Lamy P (ed), Philadelphia, WB Saunders, 1990, 452 pages, hardcover.
This volume, one of the ongoing series of Clinics in Geriatric Medicine, is edited by an eminently qualified specialist in the field of geriatric pharmacology, assisted by a number of well-qualified medical and pharmaceutical professionals. Lamy undergirds the entire undertaking with his comment in the preface that pharmaceutical treatments that may be minor to a younger person "may lead to debilitation, confusion, dry mouth, oversedation, unsteadiness, fecal impaction, or urinary incontinence in the elderly patient."
Initial chapters elaborate on the importance of geriatric clinical pharmacology, the need for sound clinical trials, and the alterations of pharmacokinetics and pharmacodynamics in the elderly. Emphasis is placed on the increased necessity for scientifically focused trials of the elderly, rather than using data collected from testing younger populations, which produce nontransferable findings because of the altered pharmacokinetics of medications in the elderly. Opposite effects of the same drug in older subjects make it apparent that generalizations are dangerous, and that individualization of drug dosages based on physiologic function is imperative.
Although adverse drug effects are thought to be higher in elders, they are difficult to document due to unreliable reporting. Various studies and reports seem to indicate that one third of the admissions for adverse drug effects admitted to hospitals were in patients over 60, and that half of the admissions over 60 for adverse drug reactions became fatalities. Factors contributing to this problem include multiple prescribes, multiple pathologies, malnutrition, multiple drug usage, lack of knowledge by prescriber or patient, and inadequate monitoring of long-term usage. Drugs most frequently associated with adverse effects that are reported in the literature include systemic steroids, nonsteroidal anti-inflammatory drugs, calcium channel blockers, beta blockers, and benzodiazepines. Others with similar problems are antihypertensives, anticholinergics, antiparkinson drugs, psychotropics, and digoxin. Specific chapters dealing with antihypertensives, analgesics, nonsteroidal anti-inflammatory drugs, antidepressants, and antipsychotics are included in this volume.
A chapter on alternate drugs explores the factors to be considered when prescribing medications for elders. The principles include drug efficacy, patient profile, medication side effects profile, interaction with other drugs, concomitant illness, ease of administration, cost, and quality of life, as well as constant reevaluation of the medication regimen. The authors suggest alternate drugs for some commonly prescribed medications.
This volume presents 1 5 chapters by different clinicians and researchers in the field of pharmacology relating to specific aspects of medications in the elderly. It is written at a professional level with generous clinical application. It should be high-priority reading for nurses, pharmacists, and physicians involved in the clinical care of older adults.