Pharmacodynamics in the Elderly
Pharmacodynamics is defined as what the drug does to the body or the response of the body to the drug; it is affected by receptor binding, postreceptor effects, and chemical interactions (see Drug–Receptor Interactions). In the elderly, the effects of similar drug concentrations at the site of action (sensitivity) may be greater or smaller than those in younger people (see Effect of Aging on Drug Response). Differences may be due to changes in drug-receptor interaction, in postreceptor events, or in adaptive homeostatic responses and, among frail patients, are often due to pathologic changes in organs.
Elderly patients are particularly sensitive to anticholinergic drug effects. Many drugs (eg, tricyclic antidepressants, sedating antihistamines, urinary antimuscarinic agents, some antipsychotic drugs, antiparkinsonian drugs with atropine-like activity, many OTC hypnotics and cold preparations) have anticholinergic effects. The elderly, most notably those with cognitive impairment, are particularly prone to CNS adverse effects of such drugs and may become more confused and drowsy. Anticholinergic drugs also commonly cause constipation, urinary retention (especially in elderly men with benign prostatic hyperplasia), blurred vision, orthostatic hypotension, and dry mouth. Even in low doses, these drugs can increase risk of heatstroke by inhibiting diaphoresis. In general, older adults should avoid drugs with anticholinergic effects when possible.