Pharmacovigilance in geriatrics – pharmacological mechanisms to prevent iatrogenic cognitive decline, sedation and falls

Cognitive decline, depression, falls, obstipation, urinary incontinence, parkinsonism and sedation are the most frequent adverse drug events occurring in the elderly or symptoms of the old aged worsened by drugs. (Renteln-Kruse, 2009). With increasing numbers of prescribed drugs, the adverse drugs events are becoming more common. However, the latter should not be considered as a predictor for a wrong-headed pharmacotherapy. There are a number of tools to monitor and prevent the risks of certain adverse drugs events.

In this lecture, the pharmacological principles of iatrogenic cognitive decline, falls and sedation are discussed. Existing strategies – so called risk-scores and the importance of the therapeutic drug monitoring (TDM) – and their benefits in clinical practice are elucidated.

The results of receptor binding assays serve often as a criterion to judge an occurred adverse drug event as the result of a prescribed drug. Unfortunately receptor occupancies and affinities received during artificial conditions in the laboratory deviate from circumstances under therapeutic drug concentrations.

¹Renteln-Kruse, W et al (2009): Iatrogene Störungen. In: Medizin des Alterns und des alten Menschen (S. 70 – 83). Steinkopff.