TY - JOUR T1 - Drug therapies in older adults (part 2) JF - Clinical Medicine JO - Clin Med SP - 155 LP - 159 DO - 10.7861/clinmedicine.15-2-155 VL - 15 IS - 2 AU - Omar Mukhtar AU - Stephen HD Jackson Y1 - 2015/04/01 UR - http://www.rcpjournals.org/content/15/2/155.abstract N2 - In this, the second of two articles, we continue our evaluation of drug therapies in older adults. Having previously described the pharmacokinetic and pharmacodynamic consequences of physiological ageing, along with the challenge of appropriate prescribing, we proposed four key questions which should be considered when prescribing for this cohort of the population. Does this agent reflect the priorities of the patient? Are there alternatives – with greater efficacy, effectiveness or tolerability – that might be considered? Are the dose, frequency and formulation appropriate? How does this prescription relate to concurrent medication? We also highlighted the reliance on subgroup analysis to demonstrate the efficacy of drug therapies for older adults in osteoporosis and the underutilisation of appropriate treatments for patients with Alzheimer's disease as a result of flawed guidelines. Here we describe current drug therapies in systolic heart failure, noting the limited inclusion of older adults in key trials, while also reviewing the pharmacological treatment of orthostatic hypotension. In doing so, we advocate the intermittent use of midodrine as a first-line treatment for orthostasis in older adults, counter to the generic guidelines produced by various learned societies, but in keeping with the scant trial data available. ER -