This chapter describes drug therapy in the elderly. A hallmark of aging in humans is the development of multiple, coexisting physiological and pathophysiological changes that may benefit from drug therapy. The age-related changes that occur in physiological or psychological function prior to drug exposure are helpful in predicting and describing a particular drug response. The most consistent and predictable age-related change in drug pharmacokinetics (PK) is that of the renal clearance of drugs. Renal function-including renal blood flow, glomerular filtration rate, and active renal tubular secretory processes-declines with increasing age. It has been found that phase II biotransformations are little changed with aging, based on the studies of glucuronidation, sulfation, and acetylation. Prototype substrates studied for glucuronidation have been lorazepam and oxazepam. Theophylline neurotoxicity and cardiotoxicity are increased in older patients. Understanding age-related pathophysiology can, in some instances, allow for the prediction of age-related changes in drug disposition and effect. Drug therapy continues to be a significant contributor to morbidity and mortality in the elderly.
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