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Clinical Pearls | Geriatric Considerations |
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Aging reduces the liver's ability to metabolize drugs, and liver disease may further compromise liver function. So can other diseases that reduce hepatic blood flow, such as heart failure. Drug metabolism by the liver depends primarily on two processes: blood flow and metabolic enzyme action. Because aging decreases blood flow to the liver, less drug is delivered to be metabolized to inactive compounds. Liver enzymes metabolize drugs in two major phases. Aging reduces the efficiency of both, but phase I reactions (oxidation, reduction, and hydrolysis of drug molecules) are affected more than phase II reactions (coupling of the drug or its metabolite with an acid to produce an inactive compound). Therefore, aging leads to different clinical effects, depending on whether a drug is metabolized in phase I, phase II, or both. |
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