Talking about how to guide the elderly to use drugs rationally.

1, the principle of five drugs. It is not appropriate for the elderly to use more than five drugs at the same time. According to statistics, when five drugs are used together, the incidence of adverse drug reactions is 4%, 6 ~ 10 is 10%,1~15 is 25%, and 16 ~ 20 is 54%. It is necessary to define the treatment objectives, grasp the main contradictions and choose the main drugs for treatment. All drugs with uncertain curative effect, poor tolerance and not taking according to the doctor's advice can be considered to stop using, so as to reduce the number of drug use. If you need to use multiple drugs when your condition is critical, you should still follow the principle of five drugs after your condition is stable. 2. The benefit principle must first have clear indications for drug use, and also ensure that the benefit/risk ratio of drug use is greater than 1. If the benefit/risk ratio of medication is less than 1 even if there are indications, medication should not be given. 3. Timing principle Timing principle is to choose the most suitable medication time according to the principles of chronobiology and chronopharmacology. Because the onset, aggravation and remission of many diseases have circadian rhythm changes (such as variant angina pectoris, cerebral thrombosis and asthma often appear at night, and the peak of acute myocardial infarction and cerebral hemorrhage is in the morning); Pharmacokinetics has circadian rhythm changes (for example, the intestinal function is relatively hyperactive during the day, so the drug absorption is faster, and the blood drug concentration is higher than that at night); Pharmacodynamics also has circadian rhythm changes (for example, the hypoglycemic effect of insulin in the morning is greater than that in the afternoon). For example, the effective time of anti-angina drugs should cover the peak period of angina pectoris attack. Variant angina usually occurs from 0: 00 to 6: 00, so it is recommended to use long-acting calcium antagonists before going to bed. However, angina pectoris usually occurs from 6 am to 1 2 am, so long-acting nitrates, P receptor blockers and calcium antagonists should be used at night. 4, the principle of stopping drugs When you suspect that there are adverse drug reactions, you should stop taking drugs for a period of time. The elderly should be closely observed during medication, and should be considered once new symptoms, including physical, cognitive or emotional symptoms, appear. For the elderly who have new symptoms after taking medicine, the benefits of stopping taking medicine are obviously more than adding medicine. Therefore, as one of the simplest and most effective interventions in modern gerontology, the principle of drug suspension deserves great attention. 5. Low dose principle: Except vitamins, trace elements, digestive enzymes and other drugs, other drugs should be lower than the adult dose. Because there is still a lack of guidelines for adjusting doses for the elderly. Therefore, the analysis should be based on the age, health status, weight, liver and kidney function, clinical situation, therapeutic index and protein binding rate of the elderly patients. If a small dose can achieve the therapeutic purpose, there is no need to use a large dose. It should be noted that it is not always a small dose, but it can be a small dose at the beginning or a small dose for maintenance treatment, which is mainly related to the types of drugs. For drugs (lidocaine, amiodarone, some antibiotics, etc. If it needs to be used for the first time, the lower limit of adult dose can be used for the first time for the elderly in order to ensure rapid onset. The principle of small dose is mainly reflected in the maintenance amount. For most other drugs, the principle of small dose is mainly reflected in the initial stage of medication, that is, starting from a small dose (adult dose of 1/5 ~ 1/4) and gradually increasing. Based on the principle of better curative effect and less side effects, the optimal dosage for each elderly patient was discussed.