Скачать или смотреть Pharmacokinetic changes with aging

Drug onset:
Decreased cardiac output → longer circulation time (+/ reduced lean body mass in elderly) → results in slower drug distribution and equilibration between body compartments → Onset is typically slower in elderly patients

1. Hepatic Metabolism: Decreased:
-reduced hepatic blood flow
-slower hepatic enzyme activity
→ prolonged drug effects for medications cleared by the liver (e.g., rocuronium, vecuronium)

2. Renal Elimination: Decreases. Reduced GFR and renal blood flow → prolonged drug effects for renally cleared medications (e.g., pancuronium has almost double DoA)

3. Butyrylcholinesterase Activity: Decreases with age → prolonged duration of action for drugs like mivacurium. (doesn't significantly affect succinylcholine metabolism)

3. Hoffman Elimination: Minimally affected by aging, making drugs like cisatracurium more predictable in elderly patients since this pathway doesn't depend on organ function

Explains why most neuromuscular blocking agents have similar weight-based potency in elderly patients compared to younger ones, but with slower onset and longer duration of action (except for cisatracurium, which is relatively unchanged due to its Hoffman elimination).