As people get older, their physiological functions gradually decline, and various physical ailments also come to the door. Sleep time is getting less and less, but taking medicine is not enough.
According to the 30-year-old human body function as 100%, excluding the interference of various disease factors, the basal metabolism of the 60-year-old will decrease 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, medicine is three parts poison! Liver and kidney are the main organs for drug metabolism and excretion, and the ability of liver and kidney to metabolize drugs decreases, which means that drug effects and toxic side effects will increase.
Research data shows that the incidence of adverse reactions in adults is 3%-12%, compared with 15.4% in the 60-69 age group and 21.3% in the 70-79 age group. It reaches 25% after the age of 80 [3].
Therefore, the elderly should never take drugs arbitrarily!
November 9, 2017, Rational Drug Use Branch of China Association of Geriatrics, Geriatrics Branch of Chinese Medical Association, Special Committee of Geriatrics of Chinese Pharmaceutical Association, Anti-aging and Geriatrics of Chinese Pharmacological Association The Dementia Special Committee jointly issued the “List of Potentially Inappropriate Drugs for the Elderly in China” (revised and simplified version) [3].
In this category, the potential adverse risks of these drugs in older adults outweigh the expected benefits and the risks are higher. There are a total of 24 drugs/classes of Class A priority warnings in the list, reminding clinicians to be extra cautious when giving these drugs to the elderly, and to be alert to the harm caused by the use of these drugs in the elderly.
Today, we’ve picked out from this directory 10 common medicines for the elderly, some of which are also in the home medicine cabinet.
Not only doctors, but the elderly themselves and their family members should also fully realize that these drugs can easily cause physical harm to the elderly if they are not used properly. It is necessary to keep in mind:
These 10 kinds of drugs, the elderly must be careful!
Source: Tencent Medical Illustrator
Speaking of ibuprofen, many people are familiar with it, and it is the most commonly used type of antipyretic and analgesic in clinical practice. Whether it’s a fever caused by the common cold or influenza, or mild to moderate headaches, joint pains, migraines, toothaches, muscle pains, neuralgias, dysmenorrhea… generally relieved.
Therefore, many elderly people encounter a headache and go to the pharmacy to buy a box of ibuprofen by relying on their rich “life experience”, thinking that it can be done, and even many people All are available at home.
Actually, the elderly are really taking this medicine! Dangerous! risk!
Although ibuprofen is an over-the-counter drug that does not require a doctor’s prescription, it can be bought at any pharmacy, but the metabolism of the elderly in the body is slow, the elderly should take a normal dose Half the dose, overdose is likely to cause liver and kidney damage, as well as adverse reactions such as gastrointestinal bleeding or ulcers, such as nausea, vomiting, stomach pain, blood in the stool, etc. If you have gastrointestinal diseases, you should pay more attention!
It is especially important to note that there are various dosage forms and specifications of ibuprofen on the market, such as suspensions, granules, tablets, sustained-release capsules, etc. You need to read the instructions carefully before taking it. , to know the dosage of each time, the interval between taking the medicine (sustained-release tablets or sustained-release capsules require a longer interval), etc.
Therefore, the elderly and those around them who always have ibuprofen (including similar antipyretic and analgesic drugs such as acetaminophen) at home need to remember 2 points about this type of drug:
1. When you get older, the dose should be reduced appropriately;
2. Take the medicine after meals and be alert to gastrointestinal discomfort.
Diabetes is the most common chronic disease among the elderly, with more than 100 million Chinese patients.
A long illness becomes a cure. For many elderly diabetic patients, taking insulin and measuring blood sugar are commonplace, and the operation is very skilled, and sometimes they even adjust their insulin dosage according to the results of blood sugar measurement.
For example, when I woke up in the morning and measured my blood sugar, I found that my fasting blood sugar was high. I mistakenly thought that the dose of insulin injected the previous day was not enough, so I increased the dose of insulin injection without authorization.
As everyone knows, increasing the insulin dose without authorization can easily cause hypoglycemia, which is very dangerous!
Also, in older adults, if hypoglycemia is not corrected in time (such as hypoglycemia that occurs at night), sudden death may occur.
Therefore, for elderly diabetic patients, the insulin dosage should be strictly adjusted under the guidance of a professional doctor. This immediate effect of the drug should be prevented from going too far :
Do not increase the amount without authorization, and be alert to low blood sugar!
Source: Tencent Medical Illustrator
Digoxin, a century-old drug, is the main drug for the clinical treatment of heart failure (heart failure) and arrhythmia. However, in the minds of clinicians, in addition to its efficacy, this century-old medicine is more impressive:
“Typical drugs with a narrow therapeutic window (ie, effective and toxic doses are very close).”
In other words: The right dose is a life-saving medicine, and the wrong dose can turn into a poisonous poison!
When using digoxin, special attention should be paid to the usage and dosage, and blood drug concentration monitoring should be performed during taking the medicine.
For example, start with a small dose for the first time, not a full dose at the beginning. The dose for people over 70 years old should be 2/3 or 3/4 of the adult dose[4]
strong>. Moreover, pay attention to individual differences. Some people take one tablet and it will have obvious effects, and some people eat the same tablet and it will be ineffective.
In addition, digoxin is a prescription drug and must be purchased strictly with a doctor’s prescription, and cannot be purchased from other places for unauthorized use. You should strictly follow the doctor’s prescription for medication, and you can’t change the dose at will if you can’t listen to an old patient or an old friend’s introduction.
Sometimes, during the medication process of elderly patients, adverse reactions of arrhythmia will occur, and visual changes may also occur during the medication, such as yellow vision (everything is yellow), green vision (everything is green), this is likely to be a signal of digoxin poisoning.
Medications for heart disease, be careful! Regularly measure the concentration, beware of poisoning!
Nifedipine, also known as Nifedipine, is also an old medicine for elderly hypertensive patients.
The most common usage: Swallow and oral, the effect is very fast, especially sublingual, it can take effect in 2 minutes. 20 minutes have the greatest effect, and blood pressure can drop rapidly in half an hour.
Not only does it work quickly, but its price is also close to the people. Compared with most antihypertensive drugs that cost hundreds at every turn, the price of nifedipine (100 tablets/bottle) is only a dozen yuan, which is definitely a conscience. price.
However, medicines are double-edged swords. A medicine that can cure high blood pressure can often lead to the danger of low blood pressure!
Therefore, for elderly patients on antihypertensive treatment, it is necessary to monitor blood pressure and identify the risk of hypotension, especially nifedipine, a drug with a rapid antihypertensive effect, needs to be strengthened Monitor to prevent the occurrence of hypotension.
Stable blood pressure is the last word. Apply antihypertensive drugs and monitor blood pressure often.
Source: Tencent Medical Illustrator
Chlorpheniramine maleate is a common ingredient in compound preparations for the treatment of colds. We are familiar with Xinkangtec, Gankang, and Gramin all contain this ingredient.
The name of chlorpheniramine is very well-known. Many elderly people have many years of drug experience and know that chlorpheniramine is anti-allergic, effective and cheap.
However, previous experience with medication, after entering old age, can no longer be based on experience.
Chlorpheniramine itself is a drug that takes a long time to metabolize and also has a sedative effect. The elderly patients are characterized by prolonged metabolic time due to decreased liver and kidney function, and are more sensitive to the effects of central nervous system depressants such as sedative effects, so Elderly patients have higher potential risks of using chlorpheniramine, such as sedation time Prolonged, lethargy, even unconsciousness, delirium, etc.
For elderly patients who use chlorpheniramine for anti-allergic treatment, half the dose is recommended to start using; if not necessary, it is not recommended for elderly patients to use chlorpheniramine containing (Instructions indicate that the ingredient is chlorpheniramine maleate) cold medicine.
It is easily not recommended, and it is halved if it is absolutely necessary.
Image source: Zhanku Hailuo
Diazepam is an unfamiliar drug name for many elderly people, while diazepam is a familiar old tablet and sleeping pill, and it is entirely dependent on it to treat insomnia.
Similar to chlorpheniramine above, diazepam (including other common hypnotics) has a longer metabolic time than young adults and is more sensitive to sedative and hypnotic effects in the elderly, so When taking this medicine, you need to pay attention to appropriate reduction, and when taking this medicine for a long time can not stop using it suddenly, you need to gradually reduce the dose until you stop the medicine.
In addition, it should be especially vigilant that the elderly are prone to wake up in the middle of the night due to the deterioration of kidney and bladder function, and the effect of medicine is often still at this time, so There will be dizziness after getting up. In this confused state, the elderly are prone to fall and even cause fractures. For the elderly who take various sedative and hypnotic drugs and their relatives, they need to have a string in their minds:
Take sleeping pills and be careful at night.
Vancomycin is the only glycopeptide antibiotic that is sensitive to certain drug-resistant bacteria, and although only in injectable form, it can only be used in hospitalized patients.
Elderly patients have decreased vancomycin clearance due to decreased renal function, which may easily lead to the accumulation of vancomycin, which in turn increases nephrotoxicity.
Therefore, for patients with renal insufficiency or underlying renal diseases, they need to inform the doctor in time when seeking medical treatment, so that the doctor can be careful when choosing medication and dosage use.
Nephrotoxic drugs, easily not recommended.
Also known as clindamycin, it is also a classic old drug for the treatment of bacterial infections. 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.
Currently there are many antibiotics to choose from, so after the clinical use has fully weighed the risk-benefit, it is not recommended for the elderly to use this drug.
However, in some lax pharmacies, you can still buy this drug at will and at a low price, so ah, remind the elderly and their family members, choose antibiotics to remember to follow Doctor’s orders, safety first.
Liver and kidney damage, easy to use.
Anisodamine, also known as 654-2, relieves smooth muscle spasms and is often used during gastrointestinal colic. We eat a bad stomach and get acute gastroenteritis. If we go to the hospital and see a doctor with severe stomach pain, the painkiller that the doctor gives is this medicine.
However, this medicine is a typical symptom but not the root, which temporarily relieves symptoms when the pain occurs, but does not cure it. There are also obvious adverse reactions, such as dry mouth, which may cause urinary retention in elderly male patients. Anisodamine covers up the real cause of pain, and is only used to relieve pain during acute gastrointestinal colic attacks. It should not be used excessively, and it should not be used for a long time!
It can cure the symptoms but not the root cause, so it cannot be eaten for a long time.
Source: Tencent Medical Illustrator
Warfarin is also a familiar name for cardiovascular patients, used to prevent and treat thromboembolic disease. It is effective orally and has a long duration of action. But this is another drug with a narrow therapeutic window: the difference between the effective dose and the toxic dose is only in the first line.
Therefore, It is very important to grasp the dosage. The dosage should be selected by a professional doctor according to the specific situation of the patient, and the dosage should be strictly followed by the doctor’s instructions. Do not adjust the dosage by yourself to avoid leakage Take or take more!
The difference between the effective dose and the toxic dose is only in the first line. Never adjust the dose without authorization.
Have you memorized the above 10 old man’s medication admonitions?
References
[1] Wang Yao, editor-in-chief. Practical Geriatrics (1st Edition) [M]. Beijing: People’s Health Publishing House, 2014: 15, 24-27.
[2] Jian Zaijin. Five principles of medication for the elderly[J]. Chinese Journal of Gerontology, 2003,22(8):510-512.
[3] Judgment Criteria for Potentially Inappropriate Drug Use in Chinese Elderly (2017 Edition), Journal of Adverse Drug Reactions, Vol. 20, No. 1, Feb. 2018.
[4] Ma Liping, Yang Fei, Cai Jinrui, et al. Prescription dose analysis of digoxin in outpatient elderly patients based on 2015 Beers criteria, China Pharmacovigilance, 2016,13(9):563 -566.
*The content of this article is for the popularization of health knowledge and cannot be used as a specific diagnosis and treatment suggestion, nor can it replace the face-to-face consultation of a licensed physician, and is for reference only.
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