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Drugs and Aging - General Principles Of Drug Therapy

patient dose pain time

Many useful strategies exist that simplify drug use in seniors (Gordon et al.). The two most useful tips are generally (1) Start low, go slow, and (2) Do one thing at once.

The "start low, go slow" principle is how clinicians globally account for the aforementioned changes in the way that the seniors handle drugs. For example, if the normal dose of sertraline (antidepressant) is 50mg daily, 25mg daily commonly would be prescribed. Then, as is common for many drugs, the drug dose is increased to a specific amount. If sertraline is normally increased to 100mg in one week, it would be increased in one and one-half to two weeks by an increment of 25mg. This lessens the chance of severe side effects from using a dose that is too high for an older person that may lead to the patient becoming sick and stop taking the drug or, worse yet, that may lead to hospitalization.

"Do one thing at once" refers to making one medication change at a time. People with more than one medical problem must often take more than one medication. After the patient has been interviewed and examined, the clinician will have ideas as to what the problems are that need to be addressed. This may involve adding, adjusting the dose, or stopping drugs that may be contributing to the problems. Whenever possible, it is essential that only one drug be added or removed (or its dose changed) at a time. Otherwise, if the patient improves or worsens after adjusting more than one drug, the clinician will not be able to determine which drug was of benefit (or detrimental). For example, consider a patient with arthritic knee pain who is prescribed aspirin and ibuprofen together for pain. If the patient's pain improves the question is: which drug helped? Which drug should they continue to take? In order to ascertain which drug was useful, the patient would have to stop one drug, see what happens, and go from there (in other words, if the pain returns, add the second drug, then see if the first drug helped at all). Such an approach is time consuming and complicated. Similarly, if the patient suffers from side effects, they will not know which drug is the offending agent. This is an undesirable scenario that could be avoided by starting with one drug, using it properly, and assessing whether or not the drug worked before adding a second drug. Furthermore, situations like this can result in a patient incorrectly being labeled as "unresponsive" to both drugs, or "allergic" or "intolerant" to both drugs.

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