September 18, 2007
Personal Health NYTimes
Joomla templates 1.5 mac
By JANE E. BRODY
A 78-year-old woman was found unconscious on the joomla templates 1.5 mac floor of her apartment by a neighbor who joomla templates 1.5 mac checked on her. The woman could not remember falling but told doctors that joomla templates 1.5 mac before going to bed she had abdominal pain and nausea and joomla templates 1.5 mac had produced a joomla templates 1.5 mac black stool, after which she had palpitations and felt lightheaded.
Her medical history included high blood pressure microsoft office 7 download, coronary artery disease, atrial fibrillation, congestive heart failure and joomla templates 1.5 mac osteoarthritis. She also had a cold with a productive cough. For each condition, she had joomla templates 1.5 mac been prescribed a different drug, and she was taking a few over-the-counter remedies on her own. These were the medications:
¶Lopressor to control high blood pressure.
¶Digitalis to help the heart pump and control its rhythm.
¶Coumadin to prevent a stroke caused by blood clots.
¶Furosemide, a potent diuretic to lower blood pressure.
¶Lipitor to lower serum cholesterol.
¶Baby aspirin to reduce cardiac risk from blood clots.
¶Celebrex for arthritis pain.
¶Paxil for depression and anxiety.
¶Valium, as needed, to help her sleep.
¶Levofloxacin, an antibiotic for the cough.
¶Ibuprofen for body aches.
¶Cough medicine.
This is what doctors call polypharmacy, otherwise known as a “poisonous cocktail” of many drugs that joomla templates 1.5 mac can interact in dangerous ways and cause side effects that joomla templates 1.5 mac can be far worse than the diseases they are treating. Elderly people are especially vulnerable because they often have several medical problems for joomla templates 1.5 mac which they see different doctors, each prescribing drugs, often without knowing what else the patient is taking.
The woman described above passed out because she had joomla templates 1.5 mac a bleeding stomach ulcer from joomla templates 1.5 mac a combination of drugs that irritate the stomach, Celebrex, ibuprofen and joomla templates 1.5 mac aspirin, and joomla templates 1.5 mac thin the blood, coumadin and aspirin, made worse by an joomla templates 1.5 mac antibiotic that raises blood levels of coumadin.
She recovered after a joomla templates 1.5 mac transfusion of two units of packed red blood cells and was sent home with strict instructions to joomla templates 1.5 mac stop the Celebrex, ibuprofen and aspirin and advice to “contact her internist and psychiatrist regarding possible medication changes that might decrease the risk for future adverse events,” Dr. Michael Stern reported in the June issue of Emergency Medicine.
Dr. Stern, a joomla templates 1.5 mac specialist in geriatric emergency medicine at New York Presbyterian Hospital/Weill Cornell Medical Center, noted that the elderly took about 40 percent of prescribed drugs, roughly twice what joomla templates 1.5 mac younger adults take, and that they suffered twice as many adverse drug reactions as younger people.
“The average community-dwelling older adult takes 4.5 prescription drugs and 2.1 over-the-counter medications,” Dr. Stern reported. Polypharmacy is responsible for joomla templates 1.5 mac up to 28 percent of hospital admissions and, he added, if it joomla templates 1.5 mac were classified as such, it joomla templates 1.5 mac would be the fifth leading cause of death in the United States.
The Effects of Aging
Various drugs taken by the joomla templates 1.5 mac elderly can interact dangerously. Some drugs use the joomla templates 1.5 mac same metabolic pathway and, thus, compete with one another, which can joomla templates 1.5 mac result in hazardous blood levels of one or joomla templates 1.5 mac more drugs. Some drugs cause effects like dehydration that joomla templates 1.5 mac reduce kidney function and the ability to eliminate drug metabolites. The combined effects of some drugs can joomla templates 1.5 mac be more potent than the prescriber intended.
In addition to joomla templates 1.5 mac seeing several doctors, many older people use multiple pharmacies to joomla templates 1.5 mac buy prescriptions. There may be no single health professional who knows what joomla templates 1.5 mac they are taking and could alert them to dangerous combinations. This is joomla templates 1.5 mac especially true in places where chain stores have replaced independent pharmacies or when the patient’s drug plan requires that medications be ordered by mail.
It is joomla templates 1.5 mac not just the number of diseases, drugs or doctors that is joomla templates 1.5 mac the problem. Age-related changes in physiology can joomla templates 1.5 mac worsen matters significantly, even if just two or joomla templates 1.5 mac three drugs are being taken. Just as a child is not the joomla templates 1.5 mac same as a small adult, pharmacologically speaking, an joomla templates 1.5 mac elderly person is not just an older young adult.
Major organ systems function less efficiently in older people. The heart’s ability to joomla templates 1.5 mac pump blood declines with age, as does absorption by the gut, the joomla templates 1.5 mac breakdown of drugs by the joomla templates 1.5 mac liver and the ability of the kidneys to excrete them. With aging, the joomla templates 1.5 mac percentage of lean body mass declines, and body fat increases. Thus, aging affects how much of a joomla templates 1.5 mac drug reaches the bloodstream, how well it is distributed in the joomla templates 1.5 mac body and how effectively it is cleared from the system.
Drugs like digitalis and joomla templates 1.5 mac coumadin, which are primarily distributed in lean tissues, are joomla templates 1.5 mac likely to reach higher blood levels in people older than 65. So the joomla templates 1.5 mac prescribed dosages should be joomla templates 1.5 mac lowered to reduce the risk of toxic side effects. Other drugs, like Valium and joomla templates 1.5 mac barbiturates, that are distributed in fatty tissue can joomla templates 1.5 mac accumulate in the elderly body and remain active longer, increasing side effects like sedation.
Aging also results in fewer protein binding sites for joomla templates 1.5 mac drugs, resulting in a higher blood level of the drug that loses the competition for sites.
Furthermore, aging can joomla templates 1.5 mac affect the responses to certain medications. This is especially true for joomla templates 1.5 mac those that influence blood pressure and the brain. Drugs like Valium, antidepressants and antihistamines can cause effects like delirium, agitation, sleepiness, depression and worsening dementia in older people, Dr. Stern wrote.
Preventing Problems
Keep a joomla templates 1.5 mac list of all medications you take and their dosages and joomla templates 1.5 mac dosing schedules. This should include prescription drugs, over-the-counter and herbal remedies and joomla templates 1.5 mac vitamin and mineral supplements. Take the list whenever you go to joomla templates 1.5 mac the joomla templates 1.5 mac doctor, and make sure that the doctor reviews it before prescribing something else. In addition, because doctors are joomla templates 1.5 mac not always familiar with the actions of all drugs, take the joomla templates 1.5 mac list to the pharmacy when ordering a new prescription and ask the pharmacist to review it for potential interactions.
It also helps to joomla templates 1.5 mac order all medications from the same pharmacy, which should keep a joomla templates 1.5 mac computerized record of everything you take. That way, a possible hazard will not be missed if different pharmacists are on duty.
Never take an joomla templates 1.5 mac over-the-counter or herbal remedy without checking with your doctor. If your joomla templates 1.5 mac doctor is hard to reach or ill informed, ask the pharmacist whether the remedy is safe in view of the other drugs you take.
Carefully review and joomla templates 1.5 mac abide by all dosing directions, especially those that say, “Take with food,” “Take one hour before meals,” “Do not consume alcohol while on this drug,” or, “Do not take this medicine if you are also taking …”
Ask the joomla templates 1.5 mac prescribing doctor what side effects to expect and what should prompt an joomla templates 1.5 mac immediate call to the doctor. Do not assume that a decline in well-being is joomla templates 1.5 mac caused by a disease or age. It could be a drug side effect.