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Volume3 Issue2
S
upporting
Y
our
P
ractice
Howcommonareadverse
drug reactions in theelderly?
Adversedrug reactions arevery
commonamong theelderly formany
reasons.Manyelderlypatients take
manydrugs; a typical elderlypatient
takes 2-6prescriptionmedications,
over-the-countermedications, natural
products, vitamins and supplements.
The fact that theyare taking somany
drugsmakes themmore susceptible
toadversedrug reactions anddrug
interactions. As Imentionedearlier,
becausedrugs aremetabolized
differentlyasweage, thepatient is
more susceptible toadverse reactions.
Adversedrug reactions anddrug
interactions areacommon reason
whyelderlypatients areadmitted to
hospital.
Are thereanydrugs in
particular thatdentists
should takeextra
precautionswith for
elderly
patients?
Older adultsoften showagreater
response todrugs that affect thecentral
nervous system (CNS), inparticular. This
means that thereare increased risks to
oral sedation inolder patients, in terms
of sideeffects andpost-operativecare.
Dosagesmust be reduced significantly
if oral sedation isused for anolder
patient.
Another drugcommonlyused in
thedental office is epinephrine in
local anesthetics. Geriatricpatients
commonlyhavecardiovascular disease
and it is therefore recommended to
limit thedosesof epinephrine toa
maximum, suchas 0.04mg. Moreover,
evenwithout ahistoryof overt
cardiovascular disease, it isprudent to
minimize theuseof epinephrine simply
due to theexpectedeffect of agingon
theheart.
Similarly, becauseof theprofound
actionof opioids in theelderly, there is
an increased likelihoodof toxicityand
adverse reactions. Therefore, if opioid
analgesics areprescribed, thedose
anddurationof use shouldbegreatly
limited.
Finally, as ageneral rule, thereare
no specificmodifications in the
pharmacotherapyof antibiotics ina
healthygeriatricpatient, but there is
ahigher riskof adverse reactions. For
instance, pseudomembranous colitis
is acomplicationof antibiotic therapy
in theelderly; it is associatedwithhigh
mortalityanddentists shouldbeaware
of that.
Given that theelderly tend
to takeahighernumber
ofprescriptionandover-
the-counterdrugs,how
canwepreventanadverse
drug reaction inourelderly
patients?
Thefirst thing is togoback tobasics.
Inmypractice, I alwaysbookextra
time for elderlypatients togoover
theirmedical historycarefully, check
whichdrugs theyare takingandwhen
theywereprescribed, and if therehave
beenanychanges in theirmedications.
I need toensure that their overall health
isunder control and that I can treat
them inmyoffice, rather than referring
them toahospital dental clinicor a
specialist.
Weneed tocriticallyassesswhether
we reallyneed to intervenewith
pharmacology. Beforewriting the
prescription, thinkwhether thebenefits
outweigh the risks. If thebenefitsof
themedicationoutweigh the risks,
thenbyallmeansmake it part of your
treatment plan. But always know there
is apossibilityof adverse reactions and
drug interactions.
Whatother things can
dentistsdo toaddress
theneedsof theirelderly
patients?
Most importantly,wehave to know
what kindof emergenciesmight
occurwithanelderlypatient andbe
prepared. For example, beaware the
signs and symptomsofmyocardial
infarction, syncope, hypoglycemia,
andhow to treat them.Wealsoneed
tomake sureour offices areaccessible
topatientswithphysical limitationsby
making themwheelchair accessible, for
example. Finally, andmost importantly,
remember to treat your elderlypatients
withcompassion.
a
Evenwithout ahistory of overt cardiovasculardisease,
it is prudent tominimize the use of epinephrine simply
due to the expected effect of aging on the heart.
Dr.Ouanounouhasparticipated ina
seriesof video interviews related to
seniors’ oral healthonOasisDiscussions.
See:
Treating theelderlypatient
Medicationabuseamong theelderly
population
Managingadversedrug reactions in
theelderly
Importanceofpolypharmacy in the
elderlypopulation
Exploringxerostomia in theelderly
