A. F. Titarenko

The relevance of studying pharmacotherapy in the elderly is due to the global aging of the population and the associated medical challenges. Elderly people suffer from multiple chronic diseases (polymorbidity), which inevitably leads to the simultaneous use of multiple drugs (polypharmacy). More than 90% of people over 65 regularly take medications, and more than half take 5 or more at a time. Age-related changes in the body (decreased liver and kidney function, changes in body composition, sensitivity of the central nervous system and cardiovascular system) radically change the pharmacokinetics and pharmacodynamics of drugs, increasing the risk of their accumulation and toxicity. The combination of polymorbidity, polypharmacy, and altered drug response creates a high risk of dangerous drug interactions (up to 87% when taking 6+ drugs), frequent and severe adverse reactions (causing 10-17% of hospitalizations), and iatrogenesis. Additional complications include a limited evidence base for this group and a significant economic burden of complications. The employment of special tools (STOPP/START criteria) to optimize therapy and prevent irrational prescriptions is a prerequisite for ensuring safe and effective treatment of the elderly.

Pharmacotherapy in neonates and nursing mothers faces unique risks due to the physiological immaturity of the child's body. In infants, delayed drug clearance due to underdevelopment of cytochrome P450 enzymes and renal function can lead to accumulation of toxins even at standard dosages. For nursing mothers, the problem is aggravated by the fact that about 80% of drugs penetrate into breast milk, creating a risk of dysbiosis, allergies, other adverse reactions, and long-term developmental disorders in the baby. Peculiarities of pharmacokinetics in newborns aggravate the risks. Metabolism and excretion are also critically different: glucuronidation deficiency provokes chloramphenicol toxicity, and low glomerular filtration increases the half-life of furosemide by 8 times. Dosage errors increase hospitalization by 30%, and treatment of complications in premature babies can reach 5 million rubles per case. All this dictates the need to develop age-oriented protocols, take into account transplacental transfer of drugs, carry out strict monitoring during lactation, and create specialized dosage forms to protect the most vulnerable groups of patients.

Drug therapy for pain syndrome is aimed at reducing pain intensity and improving the patient’s quality of life. Medicines are selected individually depending on the cause of the pain. The main pharmacological group is analgesics (non-narcotic, for example, paracetamol and NSAIDs – ibuprofen and diclofenac, and narcotic, i.e. opioids such as morphine and tramadol, which are used for severe pain, but with caution and according to certain rules and regulations due to the risk of developing addiction). Effective treatment of chronic pain requires the participation of a team of specialists: a general practitioner, neurologist, clinical pharmacologist, physiotherapist, psychologist, rehabilitation specialist, etc. Therefore, pain pharmacotherapy should or may also include drugs such as antidepressants (tricyclic antidepressants, for example, amitriptyline) or serotonin and norepinephrine reuptake inhibitors (venlafaxine, duloxetine), which are effective for neuropathic pain; anticonvulsants (gabapentin and pregabalin used for neuropathic pain); local agents (anesthetics (lidocaine patch), capsaicin creams); glucocorticoids (used to relieve inflammation, for example, for pain associated with tumors or inflammatory diseases), etc. Main treatment approaches include pharmacological, non-pharmacological, and psychosocial strategies. Non-drug treatment is aimed at improving the general condition of the body, restoring function, and reducing pain: physiotherapy (electrical nerve stimulation, laser therapy, ultrasound, heating, massages, physical therapy, acupuncture, manual therapy, etc.); surgical treatment, psychological and psychiatric care, lifestyle changes, rehabilitation, and alternative methods. This approach takes into account all aspects of the patient's condition: physical, emotional, and social ones. Treatment of chronic pain should be individualized and aimed not only at eliminating symptoms, but also at improving the patient’s quality of life.