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Dose optimisation in geriatric & pediatrics.pptx
This clinical presentation by Dr. Ankit Gaur provides a practical overview of dose optimization strategies for geriatric and pediatric patients, focusing on age-specific pharmacological nuances. It covers: - Age classifications and physiological changes influencing drug response - Pharmacokinetic and pharmacodynamic considerations - Challenges in polypharmacy and medication adherence in the elderly - Pediatric dosing principles, developmental sensitivity, and safety risks - Use of Beers Criteria, STOPP/START tools, and medication reconciliation - Strategies for individualized therapy, therapeutic monitoring, and family-centered care
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Dose optimisation in geriatric & pediatrics.pptx
- 1. Dose optimization for geriatric& pediatric patients Dr. Ankit Gaur., PharmD, MSc, MBA, RPh Clinical Pharmacologist Coordinator- Medical Device Adverse Event Monitoring Centre (MDMC) Coordinator- ADR Monitoring Centre (AMC) Kailash Hospital & Heart Institute Mobile: +91-9716574979
- 2. Dose Optimization inGeriatric Patients 🧠Balancing Efficacy and Safety in Older Adults 🧓
- 3. Definition ➔ Definition ‘Elderly’is difficult. ➔ The geriatric population are those patients who are older than 65 years.. They can be classified based on their chronological age as: ➔ Young-Old: 65 and 74 years old. ➔ Middle-Old: 75 and 84 years old ➔ Old-Old/Oldest-Old: 85 and older ➔ Centenarians: 100 years of age and older.
- 4. Definition ➔ Definition ‘Elderly’is difficult. ➔ The geriatric population are those patients who are older than 65 years.. They can be classified based on their chronological age as: ➔ Young-Old: 65 and 74 years old. ➔ Middle-Old: 75 and 84 years old ➔ Old-Old/Oldest-Old: 85 and older ➔ Centenarians: 100 years of age and older.
- 5. Definition ➔ Definition ‘Elderly’is difficult. ➔ The geriatric population are those patients who are older than 65 years.. They can be classified based on their chronological age as: ➔ Young-Old: 65 and 74 years old. ➔ Middle-Old: 75 and 84 years old
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- 7. ⚙️Pharmacokinetic Changes inAging ● Absorption: gastric acid, slower GI motility ↓ ● Distribution: body fat, lean mass and ↑ ↓ albumin ● Metabolism: liver blood flow, liver size and ↓ enzyme activity ● Excretion: renal function and GFR ↓
- 8. 🧬Pharmacodynamic Change ● Alteredreceptor sensitivity due to decrease in number of receptors ● Changes in homeostatic mechanism ● ↑ risk of adverse drug reactions (ADRs) ● Examples: exaggerated CNS effects from benzodiazepine
- 9. 💊 Polypharmacy Challenge ●Average elderly patient takes 5 medications ≥ ● ↑ risk of drug-drug interactions ● Adverse drug reactions ● Medication Errors ● Poor medication adherence
- 10. 💊 Optimization &clinical pearls ● Use tools like Beers Criteria and STOPP/START guidelines to determine dosage and necessity of current medication. ● Revise medications based on necessity ● Focus on once a day medications for better adherence ● Medication reconciliation
- 11. 💊 Optimization &clinical pearls ● Monitor therapeutic drug levels if possible ● Adjust doses based on renal/hepatic function ● Educate, counsel, listen to the patient, and involve family
- 12. 💊 Optimization &clinical pearls ● Monitor therapeutic drug levels if possible ● Adjust doses based on renal/hepatic function ● Educate, counsel, listen to the patient, and involve family
- 13. ✅Summary & Takeaways ●Geriatric dosing requires careful consideration ● Individualized therapy improves outcomes ● Safety, efficacy, and quality of life are key goal
- 14. Dose Optimization in Pediatric Patients 👶 EnsuringSafe and Effective Drug Therapy in Children🧒
- 15. ● Pediatric patientsare not small adults ● They have unique physiology and undergo developmental changes that affect drug response ● They are at more risk of medication errors, drug toxicity, adverse drug reactions that might affect their development.
- 16. Pediatric Classification ➔ Preterm Neonate:<37 weeks gestation ➔ Neonate: Birth to 27 days ➔ Infant & Toddler: 28 days to 23 months ➔ Young-Child: 2–5 years. ➔ Older Child: 6–11 years ➔ Adolescent: 12–18 years
- 17. ⚙️Pharmacokinetic Changes inAging Absorption: Variable gastric pH, delayed gastric emptying Distribution: total body water, fat and protein ↑ ↓ binding Metabolism: Immature liver enzymes Excretion: Reduced renal clearance in neonates
- 18. 🧬Pharmacodynamic Change🧠 ● Receptorsensitivity varies with age ● CNS and cardiovascular responses may differ ● Risk of exaggerated or diminished drug effect
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- 22. 💊 References ● TurnheimK. Drug dosage in the elderly. Is it rational? Drugs Aging. 1998 Nov;13(5):357-79. doi: 10.2165/00002512-199813050-00003. PMID: 9829164. ● Dorota Sarwinska, Marta Miller, Jagoda Arendt, Michał Markiewicz, Katarzyna Michta, Michael Grimm, Łukasz Balwicki, Werner Weitschies, ● Real-life dosing conditions in older adults and geriatric patients in Poland – An international questionnaire study to investigate the regional differences in drug intake behaviour in the older population, European Journal of Pharmaceutical Sciences, Volume 206, 2025, 107001, ISSN 0928-0987, https://doi.org/10.1016/j.ejps.2024.107001. ● Bereda G. Pediatrics: pharmacokinetics and dose calculation. J Pediatr Neonatal Care. 2022;12(2):96‒102. DOI: 10.15406/jpnc.2022.12.00463 ● Pediatric Pharmacotherapy, Second Edition Hardcover – October 1, 2020 by Brady S. Moffett ● https://www.merative.com/clinical-decision-support/neofax-and-pediatrics