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Elderly Psychopharmacology

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Donepezil

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Considerations: Dose adjustment may be necessary due to slower metabolism; monitor closely for GI bleeding. Potential side effects: Nausea, diarrhea, and bradycardia.

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Memantine

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Considerations: Titrate dose slowly to minimize cognitive side effects; renal function should guide dosing. Potential side effects: Dizziness, confusion, and headache.

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Sertraline

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Considerations: Start low and go slow with dosing to reduce risk of side effects; monitor for hyponatremia. Potential side effects: Insomnia, diarrhea, and increased risk of falls.

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Citalopram

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Considerations: Be cautious with dosing due to potential QT interval prolongation; conduct ECGs periodically. Potential side effects: Nausea, dry mouth, and QT prolongation.

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Mirtazapine

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Considerations: Can be beneficial for patients with insomnia or poor appetite but beware of sedation and weight gain. Potential side effects: Increased appetite, sedation, and constipation.

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Escitalopram

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Considerations: Generally well tolerated, but cautious dosing is still required; lower risk of QT prolongation than citalopram. Potential side effects: Sweating, anxiety, and sleep disturbances.

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Haloperidol

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Considerations: Increased sensitivity in the elderly; increased risk of extrapyramidal symptoms and tardive dyskinesia. Potential side effects: Akathisia, parkinsonism, and anticholinergic effects.

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Quetiapine

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Considerations: Lower risk of extrapyramidal side effects; monitor for metabolic syndrome. Potential side effects: Sedation, orthostatic hypotension, and weight gain.

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Risperidone

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Considerations: Start with low doses due to increased risk of cerebrovascular adverse events in the elderly; monitor for hyperprolactinemia. Potential side effects: Weight gain, fatigue, and increased risk of stroke.

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Lithium

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Considerations: Narrow therapeutic range in the elderly; requires frequent monitoring of lithium levels due to renal function decline. Potential side effects: Tremor, polyuria, and potential for toxicity.

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Valproate

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Considerations: Hepatic function and platelet count should be monitored; dose adjustments may be necessary due to altered metabolism. Potential side effects: Thrombocytopenia, weight gain, and hair loss.

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Carbamazepine

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Considerations: Risk of hyponatremia and potential for drug-drug interactions; periodic liver function tests recommended. Potential side effects: Ataxia, diplopia, and leukopenia.

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Gabapentin

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Considerations: Renal function determines dosing; lower doses may be required. Potential side effects: Dizziness, peripheral edema, and drowsiness.

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Tramadol

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Considerations: Risk of seizures and serotonin syndrome, especially when used with other serotonergic drugs; adjust dose in renal and hepatic impairment. Potential side effects: Constipation, nausea, and dizziness.

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Digoxin

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Considerations: Monitor serum levels for toxicity given narrow therapeutic window; renal function greatly affects dosing. Potential side effects: Cardiac arrhythmias, fatigue, and visual disturbances.

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Levodopa/Carbidopa

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Considerations: May require lower doses due to increased sensitivity; monitor for orthostatic hypotension. Potential side effects: Dyskinesias, hallucinations, and orthostatic hypotension.

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Tamsulosin

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Considerations: Monitor for orthostatic hypotension; may interact with other medications like PDE5 inhibitors. Potential side effects: Dizziness, abnormal ejaculation, and rhinitis.

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Furosemide

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Considerations: Monitor for electrolyte abnormalities and dehydration; dosing may be affected by renal function. Potential side effects: Hypokalemia, dehydration, and ototoxicity.

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Warfarin

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Considerations: Requires regular INR monitoring due to variable response and risk of bleeding; numerous food and drug interactions. Potential side effects: Bleeding, bruising, and skin necrosis.

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Amitriptyline

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Considerations: Anticholinergic burden and sedative effects can be pronounced in the elderly; lower initial dosing required. Potential side effects: Dry mouth, constipation, and orthostatic hypotension.

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