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Pharmacotherapy for Special Population

(Geriatric)

Department of Pharmacology
Faculty of Medicine
Lambung Mangkurat University 1
Age is just a number?

Changes in body composition with growth and


aging 2
Drug use in geriatric patient
• Prone for infections
• Prone for injuries
• Need special assistance
• Prone for psychological
problems
• Prone for degenerative
disorders
• Increased risk for disease
• Increased risk of disability
• Incrased risk of death

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(United Nations, 2017)
• With the accumulation of disease these is an
accumulation of treatments
– multiple medications for multiple chronic diseases
 “Polypharmacy”
– Multiple physicians
– Self-medication

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• Disproportionate use of drugs in the elderly.
– 12% of population receive 30% of all prescriptions.
– 2/3 use 1 or more drugs daily.
• Ave 5 - 12 drugs daily
• < 5% use no drugs.
• 1/3 use 1 or more psychotropic drugs each year.
• It is often difficult to distinguish between
disease and adverse drug events.

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• Aging is a continuum and the aged are
stratified by degree of age.
– Young old is 65 – 75 years
– Old – 75 – 85 years
– Old old – age > 85 years
• As age progresses so do the exceptional
considerations.
• Most systems are more affected by disease
than age alone.

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(Katzung, 2017)
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(Brenes-salazar et al., 2015)
PERUBAHAN DALAM FARMAKOTERAPI

1.Perubahan farmakokinetika
(A,D,M,E)
Absorpsi :
-Perubahan kebiasaan makan
-Lambatnya pengosongan lambung
PERUBAHAN DALAM FARMAKOTERAPI

Distribusi:
-Persentase air total dan lemak tubuh menurun.
-Perubahan rasio albumin dan globulin.
Metabolisme :
-Penurunan massa dan aliran darah hepar.
-Penurunan kemampuan hepar dalam .
penyembuhan penyakit
PERUBAHAN DALAM FARMAKOTERAPI

Ekskresi :
Penurunan kapasitas fungsi ginjal
Penurunan klirens  perpanjangan
waktu paruh (T 1/2)
PERUBAHAN DALAM FARMAKOTERAPI

• 2.Perubahan farmakodinamika
Perubahan sensitifitas reseptor
Gangguan mekanisme homeostatis
Perubahan sosial dan ekonomi
• Inadequat nutrition
• Multiple drug therapy
Efek samping obat pada usila
• Jumlah obat yang diminum ~ Efek
samping
• Resiko efek samping obat 2x dewasa
• Penambahan jenis obat meningkatkan
kemungkinan interaksi obat
Kesalahan
peresepan

Penyebab tingginya Ketidak jelasan


efek samping obat informasi
pengobatan

Kesalahan pasien
Beberapa Hal yang Harus Diperhatikan

1. Meskipun populasi usia lanjut < 15 %,tapi


peresepan mencapai 25-30%.
2. Pasien sering lupa instruksi pengobatan.
3. Pada penderita tremor/ gangguan visual
hindari pemberian obat bentuk cairan/ takar
dan etiket dibuat lebih besar.
OBAT-OBAT YANG SERING DIRESEPKAN PADA
LANSIA

Obat- obat SSP : hipnotik sedatif ataksia


analgetik narkotika
anti depresan ES >>
Obat- obat Kardiovaskuler :
anti hipertensi prioritaskan terapi
non farmakologi untuk
hipertensi ringan
Guidelines for drug prescribing in elderly

1. Know all of the patients medical problems


2. Know the pharmacology of the drugs
3. Start with small doses and titrate the drug
based on response
4. Keep dosage regimens simple
5. Be sure that visual, motor or cognitive
impairment
6. Review treatment plan and response
regularly
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