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Drug interactions in the elderly

Kristen L Lokken, Gregory T Walker, Renée M Tsolis
Non-typhoidal Salmonella enterica serovars (NTS) are generally associated with gastroenteritis; however, the very young and elderly, as well as individuals with compromised immunity, are at risk of developing disseminated infection that can manifest as bacteremia or focal infections at systemic sites. Disseminated NTS infections can be fatal and are responsible for over 600,000 deaths annually. Most of these deaths are in sub-Saharan Africa, where multi-drug resistant NTS clones are currently circulating in a population with a high proportion of individuals that are susceptible to disseminated disease...
October 8, 2016: Pathogens and Disease
Outi Laatikainen, Sami Sneck, Risto Bloigu, Minna Lahtinen, Timo Lauri, Miia Turpeinen
Adverse drug events (ADEs) are more likely to affect geriatric patients due to physiological changes occurring with aging. Even though this is an internationally recognized problem, similar research data in Finland is still lacking. The aim of this study was to determine the number of geriatric medication-related hospitalizations in the Finnish patient population and to discover the potential means of recognizing patients particularly at risk of ADEs. The study was conducted retrospectively from the 2014 emergency department patient records in Oulu University Hospital...
2016: Frontiers in Pharmacology
Ping-Ping Lin, Xue-Ning Li, Fei Yuan, Wei-Li Chen, Meng-Jie Yang, Hong-Rong Xu
Huperzine A (HupA), one of the reversible and selective acetylcholinesterase inhibitors derived from Chinese herb Huperzia Serrata, possesses affirmative action of ameliorating cognitive dysfunction of Alzheimer's disease. Up to now, the effects of HupA on human cytochrome P450s (CYPs) have not been fully elucidated. The purpose of the present study was to clarify the metabolic pathway of HupA in vitro and in vivo, and to evaluate the CYPs inhibition/induction profile of HupA in vitro. The catalytic activity of CYP enzymes (CYP1A2, 2A6, 2C9, 2C19, 2D6, 2E1 and 3A4) was measured by the quantification of specific enzyme substrates using validated liquid chromatography-tandem mass spectrometry (LC/MS/MS) methods...
October 14, 2016: Biochemical and Biophysical Research Communications
Robert M Nevels, Samuel T Gontkovsky, Bryman E Williams
Paroxetine, also known by the trade names Aropax, Paxil, Pexeva, Seroxat, Sereupin and Brisdelle, was first marketed in the U.S. in 1992. Effective for major depression and various anxiety disorders, it quickly gained a sizable share of the antidepressant prescription market. By the late 1990s, paroxetine frequently was being associated with serious drug interactions and medication side effects. Most significantly, in a major Canadian epidemiological study examining the relationship between antidepressants and diseases, paroxetine was associated with a 620 percent increase in the rate of breast cancer in women who had taken it over a four-year period...
March 1, 2016: Psychopharmacology Bulletin
Pavel Weber, Hana Meluzínová, Dana Prudius, Katarína Bielaková
Polypharmacy is common in the elderly, especially in the late age (over 75 years). Usually it is closely related to the geriatric multi-morbidity. The authors highlight the medication used in the anticipated positive and potential negative potential. While physicians often must make difficult trade-offs between the guidelines on one hand and complicated multi-morbidity, on the other hand, while trying to avoid polypharmacy ( 5 drugs), especially excessive polypharmacy ( 10 drugs). Multimorbid elderly patients who are treated in accordance with guidelines typically use large amounts of medicaments...
2016: Vnitr̆ní Lékar̆ství
Hima Bindu Gujjarlamudi
There is an increase in population of elderly above the age of 65. As age advances, more diseases develop resulting in use of more medications. Physiological changes, alterations in homeostatic regulation and diseases modify pharmacokinetics and drug response in older patients. The risk for drug interactions and drug-related problems increases along with multiple medications. Periodic evaluation of the patients' drug regimen is essential to minimize polytherapy. Clinicians must be alert to the use of herbal and dietary supplements as they are prone to drug-drug interactions...
July 2016: Journal of Mid-life Health
Johannes M Just, Klaus Weckbecker, Katja S Just
BACKGROUND: Nocturnal leg cramps are painful, involuntary muscle contractions commonly seen in elderly. While mostly harmless, they can severely impair quality of life and often disrupt sleep. Adverse drug effects may be responsible for a fraction of nocturnal leg cramps but often go unrecognized, resulting in additional prescribing intended to deal with adverse effects that might be better addressed by reduction, substitution, or discontinuation of the offending agent. CASE PRESENTATION: An 87 year old female presented as outpatient in family medicine with nocturnal leg cramps which had been present for five years and increasingly burdened her quality of life...
October 1, 2016: BMC Geriatrics
Maud Rouillard, Michel Audiffren, Cédric Albinet, Mohamed Ali Bahri, Gaëtan Garraux, Fabienne Collette
INTRODUCTION: Cognitive reserve (CR) was proposed to explain how individual differences in brain function help to cope with the effects of normal aging and neurodegenerative diseases. Education, professional solicitations, and engagement in leisure and physical activities across the lifetime are considered as major determinants of this reserve. METHOD: Using multiple linear regression analyses, we tested separately in healthy elderly and Parkinson's disease (PD) populations to what extent cognitive performance in several domains was explained by (a) any of these four environmental lifespan variables; (b) demographic and clinical variables (age, gender, depression score, and, for the PD group, duration of disease and dopaminergic drugs)...
August 12, 2016: Journal of Clinical and Experimental Neuropsychology
Shadi Shahriari, James Gordon, Reena Ghildyal
Respiratory syncytial virus (RSV) is one of the major pathogens responsible for lower respiratory tract infections (LRTI) in young children, the elderly, and the immunosuppressed. Currently, there are no antiviral drugs or vaccines available that effectively target RSV infections, proving a significant challenge in regards to prevention and treatment. An in-depth understanding of the host-virus interactions that underlie assembly and budding would inform new targets for antiviral development.Current research suggests that the polymerised form of actin, the filamentous or F-actin, plays a role in RSV assembly and budding...
September 26, 2016: Virology Journal
Aude Desnoyer, Bertrand Guignard, Pierre-Olivier Lang, Jules Desmeules, Nicole Vogt-Ferrier, Pascal Bonnabry
BACKGROUND: Potentially inappropriate prescriptions include over-prescription, which refers to prescription of more drugs than clinically needed, mis-prescription which refers to incorrect prescription of a drug that is needed (as per drug, dose, drug interactions, duration of therapy, duplication, follow-up, etc.) and under-prescription which stands for failure to prescribe drugs that are needed. They are associated with adverse drug events, increased use of health-care services, morbimortality and health-care costs, and poorer quality of life...
September 12, 2016: La Presse Médicale
Paul V Motika, David C Spencer
The treatment of epilepsy in older individuals is an increasingly important topic in neurology and an area that all treating neurologists should have familiarity with. As the population ages, the number of patients over 65 who present with new-onset epilepsy will increase, as will the complexity of their comorbid medical and neurological disorders. In older patients, seizures are often unwitnessed, or present with atypical symptoms, making the diagnosis more challenging. Additionally, there are relatively limited data to guide the use of anti-epileptic medications and other treatments in this patient population...
November 2016: Current Neurology and Neuroscience Reports
Yukichi Zenke, Satoshi Ikeda, Fumio Fukuda, Masahiro Tanaka, Hidetoshi Tanaka, Fumitaka Hirano, Akinori Sakai
UNLABELLED: There are several causes of atypical femoral fractures (AFF) in elderly Japanese patients, including longterm bisphosphonate (BP) use or bowed femoral shaft stress fractures, but the available sample size for examining AFF etiology in a single institution is limited. The purpose of this study was to categorize the characteristics of AFF by analyzing the data compiled on patients treated at our hospital and at affiliated institutes. This multicenter, retrospective, observational study included 34 AFF cases (bilateral AFF 10) in one male and 23 female patients (age range 30-90 years, mean age 73...
September 2016: Journal of UOEH
Baralee Punyawudho, Noppaket Singkham, Narukjaporn Thammajaruk, Theera Dalodom, Stephen J Kerr, David M Burger, Kiat Ruxrungtham
INTRODUCTION: Therapeutic drug monitoring (TDM) may be beneficial when applied to antiretroviral (ARV). Even though TDM can be a valuable strategy in HIV management, its role remains controversial. AREAS COVERED: This review provides a comprehensive update on important issues relating to TDM of ARV drugs in HIV-infected patients. Articles from PubMed with keywords relevant to each topic section were reviewed. Search strategies limited to articles published in English...
September 23, 2016: Expert Review of Clinical Pharmacology
Ali Alkan, Arzu Yaşar, Ebru Karcı, Elif Berna Köksoy, Muslih Ürün, Filiz Çay Şenler, Yüksel Ürün, Gülseren Tuncay, Hakan Ergün, Hakan Akbulut
PURPOSE: Due to more comorbidities, polypharmacy is common in elderly patients and drug interactions are inevitable. It is also challenging to treat an elderly patient with a diagnosis of cancer. Prevalence and clinical impacts of drug interactions and using potentially inappropriate medications (PIMs) have been studied in geriatric patients. However, these are not well defined in oncology practice. The purpose of this study is to define the prevalence of PIMs and severe drug interactions (SDIs) in elderly cancer patients and investigate the factors associated with them...
September 12, 2016: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
Rebecca L Salbu, Judith Feuer
The Beers Criteria identifies potentially inappropriate medications for patients who are 65 years of age and older. Initially published in 1991, the criteria have been updated multiple times, most recently in 2015. The Beers Criteria is a tool designed to alert health-care providers to the potential harms of specific medications so they may better tailor therapeutic regimens for their elderly patients. The expert panel of the 2015 update made changes to a number of previous recommendations and provided 2 new tables on select drug interactions and select medications requiring renal dose adjustments...
September 6, 2016: Journal of Pharmacy Practice
Fantaye Teka, Gebrehiwot Teklay, Eskindeir Ayalew, Terefe Teshome
BACKGROUND: The elderly are considered as special population, as they differ from younger adults in terms of comorbidity, polypharmacy, pharmacokinetics, vulnerability to drug-drug interactions and adverse drug reactions. Despite the fact that the elderly patients are at high risk of having drug interaction and potential adverse outcomes, studies in this regard are scarce in resource limited settings like Ethiopia. The aim of this study was to assess the prevalence and determinants of potential drug-drug interaction in elderly patients admitted to medical ward of Ayder Referral Hospital in Northern Ethiopia...
2016: BMC Research Notes
Guillaume Cayla, Thomas Cuisset, Johanne Silvain, Florence Leclercq, Stephane Manzo-Silberman, Christophe Saint-Etienne, Nicolas Delarche, Anne Bellemain-Appaix, Grégoire Range, Rami El Mahmoud, Didier Carrié, Loic Belle, Geraud Souteyrand, Pierre Aubry, Pierre Sabouret, Xavier Halna du Fretay, Farzin Beygui, Jean-Louis Bonnet, Benoit Lattuca, Christophe Pouillot, Olivier Varenne, Ziad Boueri, Eric Van Belle, Patrick Henry, Pascal Motreff, Simon Elhadad, Joe-Elie Salem, Jérémie Abtan, Hélène Rousseau, Jean-Philippe Collet, Eric Vicaut, Gilles Montalescot
BACKGROUND: Elderly patients are at high risk of ischaemic and bleeding events. Platelet function monitoring offers the possibility to individualise antiplatelet therapy to improve the therapeutic risk-benefit ratio. We aimed to assess the effect of platelet function monitoring with treatment adjustment in elderly patients stented for an acute coronary syndrome. METHODS: We did this multicentre, open-label, blinded-endpoint, randomised controlled superiority study at 35 centres in France...
August 26, 2016: Lancet
Konstantinos P Imprialos, Chrysoula Boutari, Konstantinos Stavropoulos, Michael Doumas, Vasilios G Athyros, Asterios I Karagiannis
Arterial hypertension affects more than 25% of the global population, and its prevalence is increasing with age. Arterial stiffening occurs with aging and results in a pattern of increased systolic and decreased diastolic blood pressure (BP). In the elderly population, elevated BP has been related with increased cardiovascular risk. Trials on this population have shown great benefits for morbidity and mortality from reducing systolic BP (SBP) levels to less than 150 mmHg. Most guidelines for the management of elderly hypertensive patients agree on BP reduction to less than 150/90 mmHg...
August 25, 2016: Polskie Archiwum Medycyny Wewnętrznej
Pascaline Boudou-Rouquette, Camille Tlemsani, Benoit Blanchet, Olivier Huillard, Anne Jouinot, Jennifer Arrondeau, Audrey Thomas-Schoemann, Michel Vidal, Jérôme Alexandre, François Goldwasser
INTRODUCTION: In the past decade, treatment options for metastatic renal cell carcinoma and soft-tissue sarcoma have expanded. Pazopanib was discovered during the screening of compounds that suppressed vascular endothelial growth factor receptor-2 (VEGFR-2). As other tyrosine kinase inhibitors (TKI), pazopanib is not totally specific for one target since it also inhibits stem-cell factor receptor (cKIT), platelet-derived growth factor receptors (PDGFRα, β), VEGFR-1 and -3. AREAS COVERED: Clinical pharmacology, drug-drug interactions and safety data published on pazopanib, between January 2006 and April 2016, are reviewed...
August 24, 2016: Expert Opinion on Drug Metabolism & Toxicology
Rohan Shah, Manesh R Patel
BACKGROUND: The safety and efficacy of the oral anticoagulant rivaroxaban were studied in the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF trial). A number of subanalyses of the ROCKET AF trial have subsequently analyzed the use of rivaroxaban in special patient populations. METHODS: The outcomes of the ROCKET AF trial were reviewed. The use of rivaroxaban in higher risk populations, as determined by the presence of co-morbidities included in the CHADS2 criteria, was analyzed...
August 23, 2016: Therapeutic Advances in Cardiovascular Disease
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