Admittedly, older persons belong to a special category of patients that usually have 3-4 chronic diseases. This defines the use of multiple drugs and requires more careful consideration of their interactions because there may be an increased risk of overdose or side effects. The following diseases of the elderly are likely to be the factors that usually influence pharmacokinetic and pharmacodynamic processes of patients of this particular age group:
- functional changes of different organs and systems;
- predominantly chronic course of disease;
- atypical nature of clinical manifestations of disease;
- late request for medical assistance;
- a certain socio-psychological status (Viasus et al., 2017).
Surprisingly, in my clinical practice, there were a number of cases when several of these complications were present.
Two years ago, a sixty-year-old woman was admitted to a hospital as she ran a risk of pathologic menopause. The patient had obesity, a predisposition to breast cancer, and chronic heart disease (condition investment functional changes of different organs and systems). Moreover, she suffered from hair loss and change in taste (atypical nature of clinical manifestations of the disease). Meanwhile, such a late case of menopause was atypical in general.
It took a while to come up with a personalized plan of care. Unfortunately, Norvasc had already aggravated her heart condition resulting in vasculitis. This is why I decided to prescribe her Metoprolol instead of Norvasc to illuminate that symptom. However, the patient’s obesity status was reconsidered before prescribing an exact diet. According to recent studies, “a BMI cut-point of 30 kg/m2 does not appear to be an appropriate indicator of true obesity status in post-menopausal women” (Banack et al., 2018). It means that fast weight loss could be harmful.
The same concerned HRT application as the patient had cancer predisposition. It is widely recognized by the medical society that “although less effective than HRT, SSRIs/SNRIs are demonstrated to reduce hot flashes and may be recommended for women who wish to avoid the risks of HRT” (Stubbs, Mattingly, Crawford, et al., 2017). Thus, I could not recommend her HRT because it might increase the risk of cancer. My personalized plan included the application of 1) Metoprolol – 100 mg/day in 1-2 doses; 2) Sertraline (Zoloft) – an initial dose of 50 mg/day. Fortunately, the patient stopped having hot flashes after a three-month therapy, and her vasculitis was put under control.
Banack, H. R., Wactawski-Wende, J., Hovey, K. M., & Stokes, A. (2018). Is BMI a valid measure of obesity in postmenopausal women? Menopause (New York, N.Y.), 25(3), 307–313. Web.
Viasus, D., Núñez-Ramos, J.A., Viloria, S. A., & Carratalà, J. (2017). Pharmacotherapy for community-acquired pneumonia in the elderly, Expert Opinion on Pharmacotherapy, 18(10), 957-964. Web.
Stubbs, C., Mattingly, L., Crawford, S. A., Wickersham, E. A., Brockhaus, J. L., & McCarthy, L. H. (2017). Do SSRIs and SNRIs reduce the frequency and/or severity of hot flashes in menopausal women. The Journal of the Oklahoma State Medical Association, 110(5), 272–274. Web.