# 017 Medications in Geriatric Otolaryngology

Fast Facts and Concepts #017 PDF

Authors: Luke A. Jakubowski MD, Thomas M. Kidder MD, Steven Denson MD

Objectives:

1. Identify specific medications or medication classes often used in otolaryngology that have unfavorable side effects in geriatric patients.
2. Identify alternative medications and treatments for geriatric otolaryngology patients.

ACGME Competencies: Patient care, Medical Knowledge

Context: Outpatient or inpatient

Action: Perform a review of medications to treat common otolaryngology complaints and avoid unwanted medical side effects.

Incidence/Prevalence: Unwanted medical side effects and medication related problems in the elderly are common, costly and often preventable. Recent studies of adverse drug events in elderly patients in the primary care setting and long-term care setting showed that 27% and 42% could have been prevented, respectively(1,2). The total estimated healthcare expenditures related to potentially inappropriate medications was reported at $7.2 billion(3).

Underlying Science: Common medications used in treating otolaryngologic diseases and symptoms may have unwanted side effects in the elderly population. With increasing age, pharmacokinetics changes can lead to unfavorable medical side effects. The effects of the age related pharmacokinetic changes are variable and difficult to predict.

Most factors that affect pharmacokinetics change with age. These include:  absorption, distribution, metabolism, elimination, and tissue sensitivity (4, 5). Although drug absorption does change with age, the degree of change is often not clinically significant. Drug distribution is effected by decreased total body water and lean body mass, increased body fat, decreased serum albumin and altered protein binding. These changes result in higher concentration of drugs in body fluids and prolonged half-lives of fat-soluble drugs. Metabolism of drugs changes with age. There is a reduced hepatic mass, hepatic blood flow, and decrease phase I metabolism.  This can result in decreased first-pass metabolism and decreased rate of biotransformation of some drugs. Elimination of drugs is also altered by a reduced renal plasma flow, glomerular filtration rate, and tubular secretion function. Decreased renal elimination can have affects on levels of drugs and metabolites. Lastly, tissue sensitivity is altered by the number of receptors, changes in receptor affinity, alteration in second-messenger function and cellular and nuclear responses. The geriatric patient can therefore be more or less sensitive to a drug or its metabolites.

A thorough knowledge of common medications (and their alternative medication) used in the geriatric patients with otolaryngologic diseases can prevent adverse drug events in the elderly.

References

(1) Gurwitz JH, Field TS, Harrold LR, Rothschild J, Debellis K, Seger AC, et al. Incidence and preventability of adverse drug events among older persons in the ambulatory setting. JAMA 2003 Mar 5;289(9):1107-1116.

(2) Gurwitz JH, Field TS, Judge J, Rochon P, Harrold LR, Cadoret C, et al. The incidence of adverse drug events in two large academic long-term care facilities. Am J Med 2005 Mar;118(3):251-258.

(3) Fu AZ, Jiang JZ, Reeves JH, Fincham JE, Liu GG, Perri M,3rd. Potentially inappropriate medication use and healthcare expenditures in the US community-dwelling elderly. Med Care 2007 May;45(5):472-476.

(4) Duthie EH, Katz PR, Malone ML, ScienceDirect. Practice of geriatrics. 2007:681.

(5) Tallis R, Fillit H, Brocklehurst JC. Brocklehurst's textbook of geriatric medicine and gerontology. 6th ed. London: Churchill Livingstone; 2003.

(6) Fick DM, Cooper JW, Wade WE, Waller JL, Maclean JR, Beers MH. Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Arch Intern Med 2003 Dec 8-22;163(22):2716-2724.

(7) The American Geriatrics Society 2012 Beers Criteria Update Expert Panel. American Geriatrics Society Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc 2012 Apr;60(4):616-631.

Author Affiliation: Medical College of Wisconsin, Milwaukee, Wisconsin.

Geriatric Fast Facts are edited by the faculty of the Geriatric Education Teams (GETS) program funded by the Reynolds Foundation, Kathryn Denson, MD, Steven Denson, MD, & Edmund Duthie, MD from the Division of Geriatrics, Medical College of Wisconsin, and are published by the Geriatric Fast Facts Website at the Medical College of Wisconsin. For more information write Kathryn Denson, MD. More information, as well as the complete set of Fast Facts, available at www.mcw.edu/Geriatric-Fast-Facts.htm

Copyright/Referencing Information: Users are free to download and distribute Geriatric Fast Facts for educational purposes only. Citation:

AUTHORS: Luke A. Jakubowski MD, Thomas M. Kidder MD, Steven Denson MD, Fast Fact #17: Medications in Geriatric Otolaryngology, October, 2012

Geriatric Fast Facts, available at www.mcw.edu/Geriatric-Fast-Facts.htm

Disclaimer: Geriatric Fast Facts provide educational information. This information is not medical advice. Health care providers should exercise their own independent clinical judgment. Some Geriatric Fast Facts cite the use of a product in a dosage, for an indication, or in a manner other than that recommended in the product labeling. Accordingly, the official prescribing information should be consulted before any such product is used.