Mistakes in Medication 11/11/2008 5:25 PM By CLARK GILLESPIE Contributor
Our senior medication travail has become somewhat comparable to catching a flying Jello ring. My previous column has dealt with the problems involved in our beginning and our continuing to take medication as directed. It is abundantly clear, however, that even when we faithfully follow prescribed medication instructions, we can get spattered with Jello debris in many ways. Just as an example, consider for a moment our altered senior internal environment and workings - systems upon which standard dosages and types of medication are often set free to roam:
* Chronic illnesses and disorders. Many of us survivors are burdened with chronic health problems such as cardiovascular disease, hypertension, diabetes2, arthritis and more. Under such circumstances, any medication may be metabolized less effectively.
* Multiple medications. Our senior coterie alone is responsible for swallowing over 30 percent of all prescription drugs. Some of us take up to five or more daily and at different regimented times. This situation may produce unwanted drug interactions as well as clashes with food and alcohol. Every new pill addition greatly increases this possibility.
* Complex medication schedules. Again, with multiple medications -- each with its own particular timing and dose schedule -- the more likely it becomes that we will mess up -- and mess up more frequently.
* Medication potential. Our senior medications are such that they have a greater potential for adverse reactions. A little farther along, we will look at some of them that investigators believe should go by the wayside completely.
* Age-related changes. As already alluded to, age-related changes found in normal maturing can affect the way drugs are absorbed, metabolized, distributed and removed from our bodies.
Well, then, lets see about some of these normal aging changes at work:
* Our percentage of body fat increases because our lean mass decreases. Thus more drugs now carried in fat remain in our systems longer.
*We also have an aging decrease in body fluids so drugs there carried may be more concentrated and have an exaggerated effect.
* Decreased G.I. function. Stomach emptying is delayed and medication may not be properly absorbed.
* Decreased liver function. Normal medication breakdown may be delayed by this aging effect and a build-up could follow.
* Decreased kidney function. In a similar manner, kidney function and clearance diminishes with age. Because of this change, medication that is removed by kidney filtration function may remain kidney-bound longer.
Multiple sources advise us of these and other senior medication problems. For instance, the above information was published on the internet by the Ohio Department on Aging - as were the three provisos outlined for you at the end of this column. Further, the University of North Carolina has recently published a list of common prescription medications that they say are totally inappropriate for those of us over 65, those rarely appropriate; and those sometimes appropriate. Column limitations do not provide space for anything but a few examples from each group. The full listing is available on the uncnews/unchealth website and also in the October issue of the Johns Hopkins Medical Letter on Health After 50.
Their always inappropriate list includes: Barbiturates (Seconal as but one example), Flurazepam (Dalmane), Meprobamate (Equanil), Chlorpropamide (Diabenese), Meperidine (Demerol), Pentazocine (Talwin), Dicyclomine (Bentyl) and more.
Listed as rarely appropriate includes Chlorodiazapoxide (Librium), Diazepam (Valium), Propoxyphene (Darvon), Carisoprodol (Soma) and more.
Listed as sometimes appropriate are: Amitriptyline (Elavil), Doxepin (Sinequan), Indomethacin (Indocin), Diphenhydramine (Benadryl) and again, many more.
We seniors need to be aware of these (and all other) medications and their damaging potential. And when we add to this melange the slurry of OTC medications, herbs, and potions, it becomes clear that we need to try and just duck the ring completely!
The Ohio study gives us three Jello-catching or ducking rules:
* We should make multiple daily dosing more secure by using compartmented daily pill dispensers in week-long plastic containers, or some other certain metering device that help to eliminate chance and bad memory from our medication program. And keep it available and visible - like we used to keep any open cigarette package!
* Our age-related physical changes can lead to greater drug sensitivity and reactions. We seniors must pay close attention to the types and amounts of medication we take and we need to ask specific questions of our physicians and pharmacists to reduce our chances of serious drug reactions.
* Due to our age-related changes in body function, the action of any drug may be less predictable than in younger individuals. Therefore the standard dosage of a drug may have to be altered or even reduced.
Pray that all those purported Jello rings stay where Jack Benny (who sold more Jello than anyone else in the world - ever) wanted them to stay - on our plate or in our belly!
Clark Gillespie is a retired OB/GYN who now lives in Aiken.
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Comment Title: Librium
Has anyone heard of elderly patients being treated with Librium for alcohol withdrawals or other reasons and subsequently becoming confused an in a permanent state of dimensia?
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