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DRUG USING IN THE ELDERLY, SOME OF NERVE AND BLOOD VESSEL DISEASES AND TREATMENT EFFICIENCY OF GINKGO BILOBA EXTRACT

1. Drug using in the old people
Influence of aging body to drug using.s
 
In aging process, body adaptation capacity to inner or outer factors are decreasing, inappropriate and untimely. In young people and healthy people, biological constant changes a little or fluctuates between a rather narrowthreshold, so people can evaluate one's health according to the biological constants. But inthe old people, biological indexes change a lot. So, it is difficult to evaluate one's health state according to these indexes, and it is faultier if people determine drug administration based on these indexes.

The old people have difference, so drug using must base on particular condition of each person. In case of long term motionless lying, regime lack of protid, suffering many diseases, chronicdisease with many damages in viscera organs, these result in many functional decline, affect to drug metabolism in the body. In the other hand, the elderly suffering from many diseases raise more difficulties in drug using, it should take account for drugsinteraction.

It is commonly difficult to obey medical instruction in the elderly. There are faultierin drug using in case of more age, it is common because of memory loss, blurred vision, oral difficulties due to mouth dryness, lack of respect in implementation of professional regulation. Therefore, the old people need health care professional, relative person in order to direct drug using for appropriate dosage, administration, time, kind of drugs. The old people should not take medicine on their own, it can result in unforeseen effects.
 
Situation of drugs after administration in the elderly.
Drugs are administrated in the body and experienced through 4 stages: absorption, drug binding, metabolism and elimination. Each stage changes in comparison with that of the young people.

Drug absorption

For old people, drug are commonly in form of alcohol, balm, oral tablets,suppository, sublingual tablets, etc.
Dermal absorption: In the elderly, the skin loss partial layer of keratin thus facilitates drug penetration into the body

Drug absorption in the digestion system:
-   In the elderly, stomach works slower thus affects remarkably drug absorption.
-  Small intestine is good for drug absorption because mucous membrane of small intestine have large surface, peristalsys of small intestine help drug distribution. But, in the elderly, the decrease of blood watering in the intestine results in absorption reduction. Time of maximum plasma concentration is slowly. Pharmacology is slower.
 
Drug binding
 
Drug binds to plasma protein:Plasma albuminusuallyreduces in the old people, especially in case of chronic diseases, so it is difficult for drug to bind to plasma albumin, drug are existing in free form in the blood and easily cause poisoning e.g.sulfamid, benzodiazepin, prednisone, etc.
 
Drugs binding to receptors: In the old people, some receptors are sensitive to drug such as benzodiazepine, barbiturate. In this case, active effect of drug increase manifestly.

Drug metabolism 

The liver is major organ which is responsible for drugmetabolism, and also excretion of some drugs. When the liver get old, and its function decreases, these make drugs increase their effects and toxicity.
 
Drug elimination through the kidney 
 
In the elderly, partial of nephrondwindles, the rest only takes charge of one third of the function. In case of renal failure, toxicity of the drugs increases manifestly e.g. deafness due to aminoglycosid. Renal failure results in plasma protein decrease, so drug in free form increases, active effect and toxicity also increase e.g. sulfamid, doxycyclin, etc.
 
 
Drug prescription for the old people.

Some principles need to be followed while prescribing drug for the old people.
History of disease, pre-history of disease of patients and family must be known clearly
Patients must be questioned detailedly of their prehistory of allergy, side effects while using drug.
A drug prescription must be appropriate and effective for each old people, patient's economy ability should be taken into account. It should avoid using unnecessary drug for treatment.

 
2. Some diseases of the nerve and blood vessel:
 
The people are more aged, there are more risk of diseases for the nerve,linking to the intellectual declines and disorderof advanced function of the cerebral cortex.
 
The old people may be seen in many different manifestation from mild psychological disorder to severemanner disorder. The most popularity is attention disorder and memory disorder as well as feeling disorder and character disorder. Mood of depression, forgetfulness, decline, etc. are not rare.

Remittent pain
 
Remittent artery pain is the state of painful limbsdue to the blood short age in case of effort caused by the narrow obstruction of the artery, blockage of blood circulation ofthe limbs. Pain results from the insufficiency of blood supply when oxy gen need to increase, leads to a naer obic and alkalinize meta bolism
On clinical:
Remittent pain is manifested as cramp, appears gradually after effort walking, usually in a group of particular muscle. Pain in the foot is not usually typically, due to artery blockage of leg, results to remittent walk

Disease of chronic artery obstruction of lower limbs.
 
Disease of chronic artery obstruction of lower limbs is the consequence of gradual blockage artery supplying blood for lower limbs due to atherosclerosis. The disease is more commonly seen in male and clinical manifestation majorly from 60 years of age. Risk factors of atherosclerosis are smoking, lipid metabolism disorder, diabetes, hypertension.
 
Raynaud syndrome 
 
This is peripheral vessel syndrome manifested by symptoms: blood shortage in the first stage with white fingers end and loss of the senses, followed by suffocation stage with blue fingers, and hyperemia in the final stage with red and very painful fingers. Raynaud syndrome is commonly seen in disorders of peripheral vessel, usually appears in cold weather, wet weather or in case patients feel touched, 80% of the cause of Raynaud syndrome are relating to vessel contraction due to coldness.
 
As the above mention, it must be very cautious to prescribe drug in the old people (usually special subjects with many diseases). Therefore, one of the tendency to treat efficaciously these above symptoms and diseases is using drug originated from medicinal herbs.

Ginkgo biloba is mentioned in this article has scientific nameGinkgo biloba L. familyGinkgoaceae.
-   Chemical ingredients: 
-   Major ingredients are Flavonoid belonging toflavonol group with main substanceskaempferol, quercetineandisorhamnetin; terpenic compounds, the most important ingredients arediterpeniclactoneswith typical structure.
-   Pharmacological tests exhibit that Ginkgobiloba has following effects:
On the nerve: extract of Ginkgo biloba inhibits the development on experiment and promotes the recovery of brain edema caused by poisoning chemical or damage, helps regulate the energy transformation of the brain. The extract also improves the tolerance of oxygen shortage, especially in the brain tissue; reduces edema of the retina and damage of cells in the retina.

Affects on vessel and blood circulation including: to 
regulate the tension force of the pulse,to dilate the vessel in case of vessel contraction, to increase the tension force of the blood vessel in cases of abnormal vessel dilation; to protect against the penetration of the vessel wall;  to inhibit platelet aggregation and thrombosis and to protect against local blood insufficiency and edema.
Ginkgo biloba extract deactivates toxicant free radical of oxygen, inhibits the peroxidation of the cell wall, helpsmaintain the intact property and the osmosis of the cell wall. 
 
Clinical researches prove that Ginkgo biloba extract with daily dosage 120 - 240 mgcan improve the syndromes relating to cerebral insufficiency such as Tinnitus, mental depression within 8 - 12 weeks. Clinical researches also proves the affects of Ginkgo biloba extract in the disease of peripheral arterial obstruction
 
Side effects may occur in case of long term treatment such as gastrointestinal disturbances, headaches and allergic skin reactions. This medicine may prolong bleeding time, so clinicians have warning: this medicine should not be used in patients with existing blood coagulation disorders, do not take this medicine with anticoagulant drugs (Warparin, Heparin) or groups of plateletaggregation inhibitor(Aspirin, Dipyridamol, Ticlopidin). In case of concurrent prescription, administration must follow doctor prescription with speciality.
 
Ginkgo biloba extract is indicated for the treatment of following symptoms:
 
- Decrease of memory, lack of concentration, particularly in the elderly,
- Intermittent claudication.
- Tinnitus, vertigo, deficiency of hearing.
- According to WHO, Ginkgobiloba extract is used for treatment of Raynaud's Diseases and Syndrome of vein inflammation.
 
Product OP.Can contains active ingredient: Ginkgo biloba extract(40 mg).
under 2 kinds of do sage form: Film coated tablets and Soft -gel.
Manufactured at WHO- GMP complying factory of OPC Pharmaceutical Joint Stock company
 7033   
opcpharma.com
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