Terrell Kevin M, Heard Kennon, Miller Douglas K
Department of Emergency Medicine, Indiana University Center for Aging Research, Regenstrief Institute, Inc, School of Medicine, Indianapolis, IN 46202, USA.
Am J Emerg Med. 2006 Jul;24(4):468-78. doi: 10.1016/j.ajem.2006.01.016.
The purpose of this article is to assist emergency physicians in selecting safe and effective drug therapy for seniors. Because safer alternatives exist, medications on the Beers list of potentially inappropriate medications should generally be avoided. We also review risks associated with several classes of medications: nonsteroidal anti-inflammatory drugs, benzodiazepines, and anticholinergic medications. They are associated with adverse outcomes when taken by older adults and should be used with caution. We also address the use of opioid medications in seniors. Although they are not without risk, opioids are generally safe with slow titration, precautions, and a bowel regimen to prevent constipation. Prescribers should also consider the need for estimating creatinine clearance when prescribing medications that require dosage adjustment in the setting of renal insufficiency. Two areas in need of research are identifying the proper dosing and safety of medications in seniors and prescribing with electronic decision support to assist in prescribing decisions.
本文旨在帮助急诊医生为老年人选择安全有效的药物治疗方案。由于存在更安全的替代药物，一般应避免使用“比尔斯潜在不适当药物清单”上的药物。我们还回顾了几类药物相关的风险：非甾体抗炎药、苯二氮䓬类药物和抗胆碱能药物。老年人服用这些药物会产生不良后果，应谨慎使用。我们还讨论了老年人使用阿片类药物的情况。虽然阿片类药物并非没有风险，但通过缓慢滴定、采取预防措施以及采用预防便秘的肠道护理方案，它们通常是安全的。在为肾功能不全患者开具需要调整剂量的药物时，开处方者还应考虑估算肌酐清除率的必要性。两个需要研究的领域是确定老年人用药的正确剂量和安全性，以及利用电子决策支持系统开处方以协助开处方决策。
