Which drug properties are problematic for older patients? (Select all that apply.)
a. Drugs with anticholinergic effects
b. Drugs that are highly protein-bound
c. Drugs with a short half-life
d. Drugs that undergo hepatic conjugation
e. Drugs with a narrow therapeutic range
ANS: A, B, E
Older patients are more susceptible to drug side effects, especially those that cause anticholinergic effects. Older patients have a loss of protein-binder sites for drugs, so those that are highly protein-bound will have higher than usual serum levels and can cause toxicity. Drugs with a narrow therapeutic range require closer monitoring in all patients, but especially in older patients. Drugs with a short half-life are preferred because older patients have a decreased ability to metabolize and excrete drugs. Hepatic conjugation is usually not influenced by older age, liver diseases, or drug interaction.
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