Supplemental Reading

Avorn J and Gurwitz JH. Drug use in the nursing home. Ann Intern Med 1995;123:195-204.

Briggs GG, Freeman RK, and Yaffe SJ. Drugs in Pregnancy and Lactation (5th ed.). Baltimore: Williams & Wilkins, 1998.

Hazzard WR et al. Principles of Geriatric Medicine and Gerontology (4th ed.). New York: McGraw-Hill, 1999.

Medical Letter. Some drugs that cause psychiatric symptoms. 1998;40:21-24.

Nahata MC. Variability in clinical pharmacology of drugs in children. J Clin Pharmacol Ther 1992; 17:365-368.

Rochon P and Gurwitz JH. Drug therapy. Lancet 1995;346:32-36.

Rylace GW. Pharmacology. In Rennie JM and

Roberton NRC (eds.). Textbook of Neonatology. Edinburgh: Churchill Livingstone, 1999.

Sastry BVR (ed). Placental Toxicology. Boca Baton, FL: CRC, 1995.

Case Study A Choice of Sedative

Mrs. Jones celebrated her 71st birthday by taking her grandchildren to the park. She fell while pushing the merry-go-round and broke her wrist. She has no pain now but is too uncomfortable with the cast to sleep well. She has tried soothing music, reading, and relaxing techniques but is still unable to sleep. She has requested a sleeping pill. Based on knowledge of psychotropic drugs in elderly patients, what medication would be an appropriate choice?

Answer: Benzodiazepines are effective for short-term use as sedative-hypnotics. Long-acting types with active metabolites, such as diazepam, would normally be expected to have a prolonged half-life. The half-life would be even more prolonged in Mrs. Jones because of the increase in body fat and decreased renal excretion that are typical for persons of her age. After several weeks of administration, daytime confusion may occur in this patient and may put her at risk for a fall and another serious injury. A short-acting benzodiazepine with inactive metabolites, such as oxazepam, could provide the desired effect with minimal adverse effects.

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