Goldberg P B, Roberts J
Med Clin North Am. 1983 Mar;67(2):315-31. doi: 10.1016/s0025-7125(16)31206-8.
Changes in responsiveness with age have been observed for autonomic drugs (agonists as well as antagonists, analgesics, anticonvulsants, bronchodilators, hypoglycemics, corticosteroids, and virtually every other group of drugs). As indicated earlier, however, this review is not meant to present an exhaustive treatment of the area, but rather to focus attention on the factors that contribute to alterations in sensitivity. As a secondary aim, the review serves to focus attention on the problem of adverse drug reactions, particularly those related to the practice of polypharmacy, which compounds the problem through drug interactions. As indicated in the introduction, adverse drug reactions (undesired or unwanted effects of drugs) occur more frequently in the older patient than in the young one. In the elderly, this relates to increased use of drugs, polypharmacy, diminution in the function of organs which play a role in drug distribution and elimination, and poor patient compliance. Drugs which most often result in adverse reactions in the elderly have been listed by Lamy (Table 1). It is of significance that this list includes many drugs that are obtainable over the counter without prescription, such as aspirin and antacids. Because of the widespread practice of polypharmacy in the elderly, there is an increased potential for drug interactions. Examples of drugs and the mechanisms whereby interactions occur, which are of particular significance in geriatric therapeutics, are provided in Table 3. Since monographs summarizing drug interactions have been available for a number of years, it is somewhat surprising that the magnitude of the problem is still so great. It appears clear that the more we understand about the basic changes that occur in the physiology, biochemistry, and structure of an organism as it ages, and the more we learn about basic pharmacologic principles, the better we can combine the knowledge toward the development of rational therapeutic drug regimens for the geriatric patient. For more detailed discussion, the reader is referred to Caird et al., Kayne, Vestal, Lamy, and Poe and Holloway. A summary of the major principles in prescribing drugs for the elderly, quoted from Riley, is provided in Table 2.
人们已经观察到，自主神经药物（激动剂和拮抗剂、镇痛药、抗惊厥药、支气管扩张剂、降血糖药、皮质类固醇以及几乎所有其他类别的药物）的反应性会随着年龄的增长而发生变化。然而，如前所述，本综述并非旨在对该领域进行详尽的论述，而是将重点放在导致敏感性改变的因素上。作为次要目的，本综述旨在关注药物不良反应问题，尤其是那些与联合用药相关的不良反应，联合用药会通过药物相互作用使问题更加复杂。如引言中所述，药物不良反应（药物的不良或有害作用）在老年患者中比在年轻患者中更频繁地发生。在老年人中，这与药物使用增加、联合用药、参与药物分布和消除的器官功能减退以及患者依从性差有关。拉米列出了最常导致老年人不良反应的药物（表1）。值得注意的是，这份清单包括许多无需处方即可在柜台购买的药物，如阿司匹林和抗酸剂。由于老年人中联合用药的情况普遍存在，药物相互作用的可能性增加。表3提供了在老年治疗中具有特别重要意义的药物及其相互作用发生机制的示例。尽管多年来已有总结药物相互作用的专著，但令人有些惊讶的是，这个问题的严重程度仍然如此之大。显然，我们对生物体随着年龄增长在生理、生化和结构方面发生的基本变化了解得越多，对基本药理学原理了解得越多，就越能将这些知识结合起来，为老年患者制定合理的治疗药物方案。如需更详细的讨论，请读者参考凯尔迪等人、凯恩、维斯塔尔、拉米以及波和霍洛韦的著作。表2引用了莱利的话，总结了为老年人开药的主要原则。
