When people reach old age, their physiological functions gradually decline, and various physical problems have also come to the door. Sleep time is getting less and less, but taking medicine is not enough to eat less.
Based on the calculation of 100% of the human body function at the age of 30, excluding the interference of various disease factors, the basal metabolism of the 60-year-old will decline by 8%, the lung function will decrease by 30%, and the blood flow of the liver and kidney will decrease by 30%[1].
As the saying goes, it is a medicine three points poison! The liver and kidneys are the main organs of drug metabolism and excretion, and the ability of the liver and kidneys to metabolize drugs decreases, which means that the drug effects and toxic side effects will increase as a result.
Studies have shown that the incidence of adverse reactions is 3% to 12% in adults, compared with 15.4% in the 60-69 age group, 21.3% in the 70-79 age group, and 25% after over 80 years of age [3].
Therefore, the elderly must not be willful in medication!
On November 9, 2017, the Rational Drug Use Branch of the Chinese Geriatric Health Care Medical Research Association, the Geriatrics Branch of the Chinese Medical Association, the Geriatric Pharmacy Committee of the Chinese Pharmaceutical Association, and the Anti-Aging and Alzheimer's Special Committee of the Chinese Pharmacological Society jointly issued the Catalogue of Potentially Inappropriate Drugs for the Elderly in China (Revised simplified version)[3].
In this list, the potential adverse risks of using these drugs in older adults exceed the expected benefits and are higher. There are 24 class A priority warnings in the catalogue, reminding clinicians that these drugs need to be given to the elderly with special caution and vigilance against the harm caused by the use of these drugs in the elderly.
Today, we have selected 10 kinds of commonly used drugs for the elderly from this catalog, some of which are also common medicines in family medicine boxes.
Not only doctors, but also the elderly themselves and their families around them, should also fully realize that if used improperly, these drugs can easily cause harm to the elderly's body, and it is necessary to keep in mind:
These 10 drugs, the elderly must be careful when using them!
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Speaking of ibuprofen, many people are very familiar with it, and it is the most commonly used class of antipyretic and analgesic drugs in clinical practice. Whether it is fever caused by the common cold or influenza, or mild to moderate headaches, joint pain, migraines, toothaches, muscle pain, neuralgia, dysmenorrhea... Generally alleviates.
Therefore, many elderly people who encounter a headache and brain fever rely on their own rich "life experience" to buy a box of ibuprofen in the pharmacy, thinking that they can get it done, and even many people are always available at home.
In fact, the elderly really use medicine like this! dangerous! narrow pass!
Although ibuprofen is an over-the-counter drug, do not need a doctor to prescribe, you can buy it at any pharmacy, but the elderly and the body metabolism slows down, the elderly should take the amount of half the normal dose, over-taking is likely to lead to liver and kidney damage, but also make gastrointestinal bleeding or ulcers and other adverse reactions, such as nausea, vomiting, stomach pain, blood in the stool, etc. If you have gastrointestinal diseases, you should pay more attention!
In particular, it should be noted that commercially available ibuprofen has a variety of dosage forms and specifications, such as suspensions, granules, tablets, sustained-release capsules, etc., before taking it, you need to carefully read the instructions to understand the dosage of each time, the interval between taking drugs (extended-release tablets or extended-release capsules need a longer interval) and so on.
Therefore, the elderly who often have ibuprofen (including the same kind of antipyretic analgesics such as acetaminophen) and the people around them need to remember 2 points for this type of drug:
1. When you are older, the dose is appropriately reduced;
2. Take medicine after meals, be wary of gastrointestinal discomfort.
Diabetes is the most common chronic disease among the elderly, with more than 100 million patients in China.
Long-term illness becomes a doctor. For many elderly diabetic patients, insulin injection and blood glucose measurement are commonplace, and the operation is very skilled, and sometimes even adjusts the amount of insulin according to the blood glucose measurement results.
For example, when you wake up in the morning to measure your blood sugar and find that your fasting blood sugar is high, you mistakenly think that the dose of insulin injection from the previous day is not enough, so you increase the dose of insulin injection without authorization.
As everyone knows, increasing the dose of insulin without authorization can easily cause hypoglycemia, which is very dangerous!
Moreover, if the elderly cannot correct the low blood sugar in time (such as low blood sugar that occurs at night), it is likely to lead to sudden death.
Therefore, for elderly diabetic patients, the dose of insulin should be strictly adjusted under the guidance of professional doctors, and this drug with immediate effect should be prevented from being too late:
Do not increase the amount without authorization, be wary of hypoglycemia!
Source: Tencent Medical Dictionary Medical Illustration
Digoxin, a century-old medicine, is the main clinical treatment for heart failure (heart failure) and arrhythmias. However, in the minds of clinicians, in addition to the efficacy of this century-old drug, what is more impressive is:
"Typical drugs with narrow treatment windows (i.e., effective doses and toxic doses are very close)."
In other words: the right dosage is a life-saving medicine, and a slight difference in the dose may turn into a poison that hurts the body and hurts the body!
With digoxin, special attention needs to be paid to the dosage and blood drug concentration monitoring should be carried out during the medication.
For example, the first dose should be started in a small dose, not in sufficient amounts at the beginning, and the dose for the elderly over 70 years of age should be 2/3 or 3/4 of the adult dose [4]. Moreover, it is necessary to pay attention to individual differences, some people eat a tablet with obvious effects, and some people eat a tablet as well.
In addition, digoxin is a prescription drug, which should be purchased strictly by the doctor's prescription, and cannot be purchased from other places without authorization. You should strictly follow the doctor's instructions for medication, and you can't change the dose at will after listening to the introduction of old patients or old friends.
Sometimes, in the process of taking drugs in elderly patients, adverse reactions of arrhythmias will occur, and visual changes will occur during medication, such as yellow vision (seeing everything is yellow), green vision (seeing everything is green), which is likely to be a signal of digoxin poisoning.
Heart disease medication, be cautious! Always measure the concentration, beware of poisoning!
Nifedipine, also known as heartache, is a common home drug for elderly patients with hypertension.
Most common usage: swallowing and taking, the onset of action is very fast, especially sublingual administration, 2 minutes can be effective. 20 minutes to play the maximum effect, half an hour blood pressure can drop rapidly.
Not only does it work quickly, its price is also close to the people, compared to most of the hundreds of antihypertensive drugs, nifedipine (100 tablets / bottle) is only a dozen pieces of the price is definitely a conscience price.
However, medicines are double-edged swords, and drugs that can cure high blood pressure can often lead to the danger of hypotension!
Therefore, for elderly patients with antihypertensive therapy, it is necessary to pay attention to monitoring blood pressure and identifying the risk of hypotension, especially nifedipine, which is a drug with fast antihypertensive effect, and to strengthen monitoring to prevent the occurrence of hypotension.
Blood pressure stability is the last word, the use of antihypertensive drugs, often monitor blood pressure.
Chlorpheniramine maleate is a common ingredient in compound preparations for the treatment of colds, and we are familiar with the new Contec, Gankang, gram sensitization, etc. contain this ingredient.
The name of chlorpheniramine is very well known, and many elderly people with many years of drug experience know that chlorpheniramine is anti-allergic, and the effect is good and cheap.
However, the previous medication experience, after entering the old age, can no longer act on experience.
Chlorpheniramine itself is a drug with a relatively long metabolic time, and it also has a sedative effect. Elderly patients are characterized by prolonged metabolic time due to decreased liver and kidney function, and are more sensitive to the efficacy of central nervous system suppression such as sedation, so the potential risk of chlorpheniramine in elderly patients is higher, such as prolonged sedation time, drowsiness, and even unconsciousness, delirium, etc.
For elderly patients on chlorpheniramine for antiallergic therapy, it is recommended to start with a dose reduction in half; if necessary, it is not recommended that elderly patients use cold medicines containing chlorpheniramine (the ingredient labeled in the instructions is chlorpheniramine maleate).
It is not recommended easily, and it is halved if it is not necessary.
Diazepam is a strange drug name for many elderly people, while diazepam tablets are familiar old pills, sleeping pills, and the treatment of insomnia depends on it.
Similar to the above chlorpheniramine, tranquilizers (including other common hypnotic drugs) for the elderly, the metabolic time is longer than that of young adults, and the sedative hypnotic effect is more sensitive, so it is necessary to pay attention to appropriate reduction when taking it, and it is not possible to suddenly stop using this drug for a long time, and it is necessary to gradually reduce the dose until the drug is stopped.
In addition, especially should be vigilant is that the elderly due to kidney and bladder function degradation, easy to get up in the middle of the night, and this time often the effect is still there, so there will be dizziness after getting up, in this confused state the elderly are easy to fall down or even lead to fractures, for the elderly who take a variety of sedative hypnotic drugs and their relatives around them, the mind needs to have a string:
Take sleeping pills and be careful when you get up at night.
Vancomycin is the only glycopeptide antibiotic sensitive to certain resistant bacteria and, although only in an injectable form, can only be used in hospitalized patients.
Elderly patients due to renal dysfunction, the clearance of vancomycin is decreasing, easy to cause vancomycin accumulation, and then increase renal toxicity.
Therefore, for patients with renal insufficiency or patients with underlying kidney diseases, it is necessary to inform the doctor in time when seeking medical treatment, so that the doctor can use it carefully in the choice of medication and dosage.
Nephrotoxic drugs, easily not recommended.
Also known as chlorphenicol, it is also a classic old medicine for treating bacterial infections. Because the results of allergic reactions are more serious, including anaphylactic shock, high fever, chills, laryngeal edema, dyspnea, etc., and may lead to abnormal liver and kidney function.
There are currently more antibiotics to choose from, so the use of the drug is not recommended for the elderly after the clinical medication has fully weighed the risks - benefits.
However, in some lax management pharmacies, you can still buy this drug at will, and the price is cheap, so ah, to remind the elderly and their families around, choose antibiotics and remember to follow the doctor's advice, safety first.
Liver and kidney damage, easy not to use.
Scopolamine, also known as 654-2, relieves spasms of smooth muscles and is often used during gastrointestinal colic. We have acute gastroenteritis when we eat bad stomachs, and if the stomach hurts badly when we go to the hospital, the painkiller injection given by the doctor is this medicine.
However, this drug is typical of the symptoms, not the root cause, and can temporarily relieve symptoms during the onset of pain, but cannot be cured. At the same time, there are obvious adverse reactions, such as dry mouth, which may cause urinary retention in elderly male patients. Scopolamine will mask the real cause of pain, only for the relief of pain during acute gastrointestinal colic attacks, not excessive use, let alone long-term use!
Symptoms are not cure, and cannot be eaten for a long time.
For patients with cardiovascular disease,
It is also a familiar drug name for the prevention and treatment of thromboembolic diseases. Oral administration is effective and has a long duration of action. But this is another drug with a narrow treatment window: the effective amount and the amount of poisoning are only between the first line.
Therefore, the grasp of the dose is very important, should be selected by a professional doctor for the specific situation of the patient, you need to strictly follow the doctor's instructions, can not adjust the dose, to avoid missing or taking more Oh!
The difference between the effective amount and the amount of poisoning is only between the first line, and the dose should never be adjusted without authorization.
The above 10 old people's drug proverbs, have you remembered?
bibliography
Wang Yao, Editor-in-Chief. Practical Geriatrics (1st Edition)[M].Beijing:People's Medical Publishing House,2014:15,24-27.
[2] Stomp in Gold. Five principles of medication for the elderly[J]. Chinese Journal of Geriatrics,2003,22(8):510-512.
[3] Criteria for judging potential inappropriate medication in the elderly in China (2017 edition), Journal of Adverse Drug Reactions, Vol. 20, No. 1, February 2018.
Ma L P, Yang F, Cai J R, et al. Dose analysis of digoxin in elderly outpatients based on 2015 Biles standard, Chinese Pharmacovigilance, 2016,13(9):563-566.
*The content of this article is a popularization of health knowledge and cannot be used as a specific diagnosis and treatment recommendation, nor is it a substitute for face-to-face consultation by a practicing physician, for reference only.
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