Picozzi A, Neidle E A
Dent Clin North Am. 1984 Jul;28(3):581-93.
The information presented in this article suggests that the drug responses of the elderly may be greater than those in the young or essentially the same. We have presented evidence that the pharmacokinetics in the elderly would probably tend toward prolonging the half-life and delaying the clearance of many drugs. Pharmacodynamic changes are more ambiguous, increasing sensitivity to some drugs and decreasing sensitivity to others. Compliance errors, from whatever cause, lead to unpredictable intake of drugs. Psychosocioeconomic factors contribute to compliance errors and no doubt also lead to increased intake of combination of drugs. Multiple diseases are common among the elderly, but it is not clear how disease states, per se, affect drug responses unless the specifically diseased organ is focally important in the handling of drugs. Alterations in perception of pain and in reflex and immune competence will produce changes in all directions. Use of multiple drugs almost certainly will create an environment favorable to drug interactions and adverse reactions. What is the dentist to do with these conflicting effects of aging in drug therapy? There are a few, and only a few, rules that can be said to have a solid basis in fact. Elderly patients seem to be more sensitive to the depressant effects of drugs. It is wise, therefore, to reduce the dosage of such drugs as the benzodiazepines, general anesthetics, analgesics, and sedative-hypnotics in the elderly. Old people are apparently more sensitive to certain drugs, for example, the neuromuscular blocking drugs. It would be wise to reduce the dosage of these for the older patient. The geriatric person appears to be less sensitive to pain; it would be wise to prescribe analgesics for such patients in lower doses. Elderly patients are known to have lost some of their reflex ability to maintain homeostasis. This should be taken into consideration when drugs that affect blood pressure, heart rate, and smooth muscle tone are used. Elderly patients are almost certain to be taking multiple medications. Drug interactions, as well as adverse drug reactions (which are exaggerated in the elderly), are likely to occur in this polypharmaceutical setting. It is critical that the dentist be continually informed of the pharmacologic status of each patient and be aware of the likelihood of interactions between drugs prescribed by the dentist, drugs-prescribed by the physician, and drugs that are self-administered.
本文所呈现的信息表明，老年人的药物反应可能比年轻人更大，或者基本相同。我们已给出证据，老年人的药代动力学可能倾向于延长许多药物的半衰期并延迟其清除。药效学变化则更为模糊，对某些药物的敏感性增加，而对另一些药物的敏感性降低。无论何种原因导致的依从性错误，都会导致药物摄入不可预测。社会心理经济因素会导致依从性错误，并且无疑也会导致联合用药增加。多种疾病在老年人中很常见，但疾病本身如何影响药物反应尚不清楚，除非特定患病器官在药物处理中具有重要作用。疼痛感知以及反射和免疫能力的改变会产生各种变化。几乎可以肯定，多种药物的使用会营造一个有利于药物相互作用和不良反应的环境。在药物治疗中，牙医该如何应对衰老带来的这些相互矛盾的影响呢？有一些——而且只有少数——规则可以说是有坚实的事实依据。老年患者似乎对药物的抑制作用更敏感。因此，明智的做法是减少老年人使用苯二氮䓬类药物、全身麻醉药、镇痛药和镇静催眠药等药物的剂量。老年人显然对某些药物更敏感，例如神经肌肉阻滞药物。对老年患者减少这些药物的剂量是明智的。老年人似乎对疼痛不太敏感；给这类患者开较低剂量的镇痛药是明智的。已知老年患者维持体内平衡的一些反射能力有所丧失。在使用影响血压、心率和平滑肌张力的药物时应考虑到这一点。老年患者几乎肯定在服用多种药物。在这种多药联用的情况下，很可能会发生药物相互作用以及药物不良反应（在老年人中会更严重）。至关重要的是，牙医要持续了解每位患者的药理状况，并意识到牙医开的药、医生开的药以及患者自行服用的药物之间相互作用的可能性。
