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Erschienen in: Zeitschrift für Gerontologie und Geriatrie 5/2015

01.07.2015 | CME Zertifizierte Fortbildung

Analgetika beim geriatrischen Patienten

Unerwünschte Arzneimittelwirkungen und Interaktionen

verfasst von: PD Dr. Markus Gosch

Erschienen in: Zeitschrift für Gerontologie und Geriatrie | Ausgabe 5/2015

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Zusammenfassung

Schmerzen stellen ein häufiges Symptom in der Medizin dar. Eine besonders hohe Prävalenz findet sich bei älteren und chronisch-kranken Bevölkerungsgruppen. Bei multimorbiden, geriatrischen Patienten stellt die pharmakologische Schmerztherapie die Erweiterung einer bereits bestehenden Multimedikation dar. Neben der Wirksamkeit der analgetischen Therapie gilt es hier besonders auf unerwünschte Arzneimittelwirkungen (UAW) und Interaktionen zu achten. Abgesehen von der Zahl der Medikamente sind es die mit dem Alterungsprozess einhergehenden pharmakodynamischen und -kinetischen Veränderungen, die das Risiko einer UAW beim geriatrischen Patienten signifikant erhöhen. Der Einsatz von nichtsteroidalen Antirheumatika (NSAR) ist weitverbreitet. Sie stellen unzweifelhaft das größte Gefahrenpotenzial dar. Gastrointestinale, kardiovaskuläre, renale und Wirkungen auf das Gerinnungssystem stehen im Vordergrund. Paracetamol hat neben der bekannten (in hohen Dosen) toxischen Wirkung auf die Leber ähnliche Interaktionen wie die NSAR, allerdings in geringerem Ausmaß. Metamizol ist nach der aktuellen Studienlage besser als sein Ruf. Das Interaktionspotenzial dürfte als gering anzusehen sein, allerdings ist die Datenlage insgesamt dürftig. In Bezug auf Tramadol und einige stark wirksame Opioide sind v. a. das Serotoninsyndrom und die sedierende Wirkung zu beachten. Aufgrund des erheblichen Gefahrenpotenzials bei Multimorbidität und -medikation gilt es bei geriatrischen Patienten zu überlegen, vom Stufenschema der World Health Organization (WHO) zugunsten einer individuellen Schmerzbehandlung abzuweichen.
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Metadaten
Titel
Analgetika beim geriatrischen Patienten
Unerwünschte Arzneimittelwirkungen und Interaktionen
verfasst von
PD Dr. Markus Gosch
Publikationsdatum
01.07.2015
Verlag
Springer Berlin Heidelberg
Erschienen in
Zeitschrift für Gerontologie und Geriatrie / Ausgabe 5/2015
Print ISSN: 0948-6704
Elektronische ISSN: 1435-1269
DOI
https://doi.org/10.1007/s00391-015-0922-z