A 76-year-old female is seen in the clinic with numerous medical complaints. She is scheduled to undergo elective surgery for right hip replacement. She says she is tired, has a very poor appetite, and does not sleep well at night. She denies any fevers, chills, chest pain, or shortness of breath. Her ECG and chest x-ray are normal. She cannot remember which medications she takes. What is the most important factor in perioperative adverse drug reaction in the elderly population?

Question

A 76-year-old female is seen in the clinic with numerous medical complaints.  She is scheduled to undergo elective surgery for right hip replacement.  She says she is tired, has a very poor appetite, and does not sleep well at night.  She denies any fevers, chills, chest pain, or shortness of breath.  Her ECG and chest x-ray are normal.  She cannot remember which medications she takes.  What is the most important factor in perioperative adverse drug reaction in the elderly population?

Quizplus · Accepted Answer

Explanation: Multiple medications are the most common factor in predisposing elderly patients to an increased incidence of adverse drug reactions. Patients over age 65 take an average of two to six prescribed drugs and one to three non-prescription drugs daily. These patients are at an increased risk preoperatively for anesthetic and operative drug reactions. The most common medications associated with adverse drug reactions include anti-psychotics, anti-hypertensives, sedatives, diuretics, NSAIDs, corticosteroids, and digoxin. (Choice D)Most elderly patients have an increased gastric pH, which tends to increase the absorption of drugs, thereby adding to the circulating levels of antagonistic compounds. (Choices C and E)The gradual reduction in the glomerular filtration rate in the elderly also adds to the circulating drug levels. This is further compounded by the fact that elderly patients have reduced levels of total body water. (Choice A)Age, itself, does not increase the risk of a perioperative adverse drug reaction. Educational Objective: Multiple medications are a major cause of adverse drug reactions in the elderly.

A 76-Year-Old Female Is Seen in the Clinic with Numerous