Drug therapy in the elderly 老年人药物治疗 1
Drug therapy in the elderly 老年人药物治疗 Drug therapy in the 1
The elderly According WHO,elderly means Age more than 65 years. Four groups: 100y 85y oldest old 75y oldold 65y middle old young old 2
According WHO, elderly means Age more than 65 years. Four groups: The elderly 75y 65y y o u n g o l d m i d d l e o l d According WHO, elderly means Age more than 65 years. The elderly 85y 100y o l d e s t o l d 2 m i d d l e o l d o l d o l d o l d o l d
Problem of aging population in China 2010 Total population 2050 Total population 1.7 hundred million 4.5 hundred million 12 hundred million 10.7 hundred million ■>65y ■>65y ■<65y ■<65y rcentage of the elderly 12%in2010 30%in2050 3
Problem of aging population in China 1.7 hundred million 12 hundred million 12% in 2010 Percentage of the elderly 4.5 hundred million 3 10.7 hundred million 30% in 2050
Adverse Drug Reaction(ADR)is common in elderly >More ADR More Disease→More Drugs→More ADR Serious ADR is common Death caused by ADR serious ADR hospitalization caused by ADR 58.0% ■elde ■elderly 15%30% 50% ■othe ■others ■ elderly ■others 4
Adverse Drug Reaction(ADR) is common in elderly More Disease More Drugs Serious ADR is common More ADR 58.0% hospitalization caused by Adverse Drug Reaction(ADR) is common in elderly More Drugs More ADR 4 50% hospitalization caused by ADR elderly others 15%∼30%
How to use drugs in elderly Think about how to use drugs in elderly from a case 5
Think about how to us from a case How to use drugs in elderly ? t how to use drugs in elderly 5
Medical history Male,88 years old,be in hospital with a cough and expectoration for 5 days,other symptoms including muscle pain,fatigue,weak,body ache,dizziness.White phlegm easy to cough,no fever,no chest pain,no hemoptysis(咯血)，etc. After hospitalization,muscle pain was more and more serious,with chest pain, without numbness of limb,no swelling of joints and skin rash. Pysical examination:muscle strength decrease,pathology (-) 浑身肌肉 6
Medical history Male , 88 years old，be in hospital with a cough symptoms including muscle pain, fatigue, weak, body easy to cough, no fever, no chest pain, no hemoptysis( After hospitalization, muscle pain was more and more serious, with chest pain, without numbness of limb, no swelling of joints and skin rash. Pysical examination：muscle strength decrease cough and expectoration for 5 days, other , fatigue, weak, body ache, dizziness. White phlegm easy to cough, no fever, no chest pain, no hemoptysis(咯血), etc. 6 muscle pain was more and more serious, with chest pain, without numbness of limb, no swelling of joints and skin rash. muscle strength decrease，pathology（-）
uffer from sixteen kinds of disease Pulmonary infection肺部感染 Type2 diabetes2型糖尿病 Cervical spondylosis?颈椎病 Peripheral atherosclerosis,renal artery stenosis. Lumbar vertebra compression fracture腰椎压缩性骨折 外周动脉粥样硬化，肾动脉狭窄 Multiple lacunarin farction多发性腔隙性脑梗塞 Lower limb artery occlusion.下肢动脉闭塞 Vertebrobasilar insufficiency?椎基底动脉供血不足 Prostate cancer]前列腺癌 Coronary heart disease,,angina pectoris..冠心病，心绞痛 open angle glaucoma开角型青光眼 Sick sinus syndrome.病态窦房结综合征 Gout痛风 High blood pressure level 3,extremely high risk. Aplastic anemia of erythrocyte.红细胞再生障碍性贫血 高血压病3级，极高危 prostatic hyperplasia前列腺增生
suffer from sixteen kinds of disease • Pulmonary infection肺部感染 • Cervical spondylosis颈椎病 • Lumbar vertebra compression fracture腰椎压缩性骨折 • Multiple lacunarin farction多发性腔隙性脑梗塞 • Vertebrobasilar insufficiency椎基底动脉供血不足 • Coronary heart disease, angina pectoris.冠心病，心绞痛 • Sick sinus syndrome.病态窦房结综合征 • High blood pressure level 3, extremely high risk. 高血压病 3级，极高危 suffer from sixteen kinds of disease • Type 2 diabetes 2型糖尿病 • Peripheral atherosclerosis, renal artery stenosis. 外周动脉粥样硬化， 外周动脉粥样硬化，肾动脉狭窄 • Lower limb artery occlusion.下肢动脉闭塞 • Prostate cancer前列腺癌 • open angle glaucoma开角型青光眼 • Gout 痛风 • Aplastic anemia of erythrocyte.红细胞再生障碍性贫血 • prostatic hyperplasia 前列腺增生
ledication in this patient (21) Atovastatin Clopidogrels氯吡格雷 。 Acarbosel阿卡波糖 (for Coronary heart disease) Ciclosporin (for Aplastic anemia) Bicalutamide比卡鲁胺 Ceftazidime头孢他啶 Amlodipine氨氯地平 Tamsulosin:坦索罗辛 Ambroxolhydrochloride Estazolam艾司唑仑 Reduced glutathione 盐酸氨溴索 Irbesartan厄贝沙坦 还原型谷胱甘肽 Alprostadil前列地尔 Megestrol!甲地孕酮 Isosorbide硝酸异山梨西 Aceglutamide乙酰谷酰胺 Thymopentin胸腺五肽 Polyenoid多烯磷脂酰L Pantoprazole泮托拉唑 Codein可待因 XUE SHUANG TONG
Medication in this patient （21 Atovastatin (for Coronary heart disease) Ceftazidime头孢他啶 Ambroxolhydrochloride • Clopidogrel氯吡格雷 • Ciclosporin (for • Amlodipine氨氯地平 Ambroxolhydrochloride • Estazolam艾司唑仑 盐酸氨溴索 Alprostadil前列地尔 Aceglutamide乙酰谷酰胺 Pantoprazole泮托拉唑 • Estazolam艾司唑仑 • Irbesartan厄贝沙坦 • Megestrol甲地孕酮 • Thymopentin胸腺五肽 • Codein可待因 21 ） 氯吡格雷 (for Aplastic anemia) 氨氯地平 艾司唑仑 • Acarbose阿卡波糖 • Bicalutamide比卡鲁胺 • Tamsulosin坦索罗辛 艾司唑仑 • Reduced glutathione 厄贝沙坦 甲地孕酮 胸腺五肽 • Reduced glutathione 还原型谷胱甘肽 • Isosorbide硝酸异山梨酯 • Polyenoid多烯磷脂酰胆碱 • XUE SHUANG TONG
Biochemical test result of blood eletal muscle damage(+) cardiac muscle tissue damage(-) muscle tissue damage(+) 个 个 Time Creatine Creatine BNP ALT AST kinase Kinase Myohemo- Troponin Vreatinine (CK) isoenzyme globin pg/ml IU/L I0/L IU/L (CK-MB) (肌红蛋白) (ng/) umol/L ng/ml (ng/ml) 02.08 6527 33.78 >3000 106.7 377 115 233 115.1 (am) 02.08 49.84 >3000 124.6 375 (pm) 02.09 8065 42.93 >3000 122.0 373 137 287 95.6 02.10 49.10 >3000 152.8 460 >3000 02.12 11003 35.58 161.7 511 188 372 112.3
Biochemical test result Time Creatine kinase （CK） IU/L Creatine Kinase isoenzyme (CK- MB) ng/ml Myohemo globin (肌红蛋白 (ng/ml) 02.08 (am) 6527 33.78 ＞3000 Skeletal muscle damage(+) cardiac muscle tissue damage( (am) 02.08 (pm) ------- 49.84 ＞3000 02.09 8065 42.93 ＞3000 02.10 ------- 49.10 ＞3000 02.12 11003 35.58 ＞3000 result of blood Myohemo- 肌红蛋白) Troponin (ng/L) BNP pg/ml ALT IU/L AST IU/L Vreatinine umol/L 106.7 377 115 233 115.1 cardiac muscle tissue damage(-) muscle tissue damage(+) 124.6 375 ------- - ------ -- -------- 122.0 373 137 287 95.6 152.8 460 ------- - ------ -- -------- 161.7 511 188 372 112.3
Questions >What kind of disease resulted in these symptoms? Whether this symptoms are related with 口Myopathy肌病？ ▣ ADR? Before we can make a diagnosis,Let us look at some suspected drugs
Questions ？ What kind of disease resulted in these symptoms? Whether this symptoms are related with Myopathy Myopathy肌病？ ADR? Before we can make a diagnosis, Let us look at some suspected drugs. What kind of disease resulted in these symptoms? Whether this symptoms are related with