Beer's Criteria Flashcards
Rationale for first gen antihistamines to be on Beer’s Criteria?
Give some examples.
When is it ok to use first gen antihistamines?
- Highly anticholinergic
- Incr risk of confusion, dry mouth, constipation, incr risk of falls, delirium and dementia
OK to use dimenhydramine in acute Tx of severe allergic reactions.
Examples: chlorpheniramine, brompheniramine, dimenhydrinate, hydroxyzine, promethazine, triprolidine
Rationale for nitrofurantoin to be on Beer’s Criteria?
When to avoid?
- Potential for pulmonary toxicity, hepatoxicity, peripheral neuropathy esp with long term use
Avoid in CrCl <30ml/min
Rationale for Aspirin to be on Beer’s Criteria?
Is it recommended to avoid for primary prevention or secondary prevention of CV disease?
- Incr risk of bleeding
- Avoid initiating for primary prevention. Secondary prevention OK
Rationale for Warfarin to be on Beer’s Criteria?
When is it ok to use warfarin? (2 scenarios)
- Higher risk of major bleeding compared to DOACs for AFib or VTE (DOACs more preferred)
- Use only if DOACs are C/I. OK to continue for adults who have already been on long-term warfarin with well-controlled INR.
Rationale for Rivaroxaban to be on Beer’s Criteria?
(For long-term Tx of AFib or VTE)
What is the recommendation?
- Higher risk of major and GI bleeding in older adults compared to other DOACs like Apixaban
- Avoid in long-term Tx and use safer anticoagulant alternatives
Rationale for non-selective peripheral alpha-1 blockers to be on Beer’s Criteria for Tx of hypertension?
What is the recommendation?
Name some examples.
- High risk of orthostatic hypotension. Avoid as antihypertensive agent.
Also aggravates incontinence -> avoid in elderly with UI
Examples: doxazosin, terazosin, prazosin
Rationale for Dipyridamole to be on Beer’s Criteria?
- May cause orthostatic hypotension
Rationale for central alpha-agonists to be on Beer’s Criteria for Tx of hypertension?
What is the recommendation?
Name some examples.
- High risk of CNS ADEs + bradycardia & orthostatic hypotension
- Avoid use as anti-HTN
Examples: clonidine, guanfacine
Rationale for nifedipine IMMEDIATE RELEASE on Beer’s Criteria?
What is the recommendation?
- Potential for hypotension, risk of precipitating myocardial ischemia (reduced blood flow to heart)
- Avoid
Rationale for Amiodarone for AFib on Beer’s Criteria?
When is it OK to use?
- Greater toxicities than other antiarrhythmics used in AFib
- OK to use if has comcomitant HF with substantial left ventricular hypertrophy; when rhythm control is preferred over rate control
Rationale for Digoxin on Beer’s Criteria? (For Tx of AFib or HF)
- Avoid this rate control agent as first-line in rate control agent in AFib
- Avoid as first-line Tx for HF
Rationale for Antidepressants on Beer’s Criteria? (What class?)
Give some examples.
- Highly anticholinergic, sedating, orthostatic hypotension
Examples: all TCAs (eg amitriptyline, clomipramine, nortriptyline) + paroxetine (SSRI)
Rationale for Antiparkinsonian agents on Beer’s Criteria as Tx for EPSE of antipsychotics?
Give some examples
- Highly anticholinergic, sedating, orthostatic hypotension
Examples: benztropine, trihexyphenidyl
Rationale for antipsychotics agents on Beer’s Criteria in pts with dementia?
When is it OK to use?
Give some examples
- Incr risk of stroke and greater rate of cognitive decline in pts with dementia
- OK to use in FDA-approved indications like schizo, tx of PD-psychosis, adjunctive to MDD Tx (quetiapine, clozapine or pimavanserin preferred)
Examples: FGA (haloperidol), SGA (quetiapine, aripiprazole, olanzapine, risperidone etc.)
Rationale for Barbiturates on Beer’s Criteria?
(Eg. Butalbital, Phenobarbital, Primidone)
- High rate of physical dependence
Rationale for BZDs on Beer’s Criteria?
Avoid with concomitant administration of?
Give some examples
- Risks of abuse, misuse and addiction
- Incr risk of cognitive impairment, delirium, falls, fractures, motor vehicle crashes
- Avoid concomitant use of opioids -> profound sedation, respiratory depression, coma and death
Examples: lorazepam, diazepam, alprazolam
Rationale for androgens on Beer’s Criteria?
Eg. methyltestosterone, testosterone
- Potential for cardiac problems
Rationale for nonBZD BZD receptor agonist hypnotics (Z-drugs) on Beer’s Criteria?
- ADEs of delirium, falls, fractures, hospitalizations, motor vehicle crashes
Rationale for Estrogen on Beer’s Criteria?
What is the recommendation?
- What about vaginal cream or tablets?
- For those who start on HRT at age 60 and older, risks > benefits. Incr risk of heart disease, stroke, blood lots and dementia
- Do not initiate systemic estrogens + consider deRx-ing among older women alr using the medication
- Acceptable to use low-dose intravaginal estrogen to manage dyspareunia, recurrent UTI, other vaginal SSx
Rationale for insulin sliding scale on Beer’s Criteria?
What is the recommendation?
- Higher risk of hypoglycemia
- Avoid regimens that ONLY contain short- or rapid-acting insulin without concurrent use of basal- or long-acting insulin
Rationale for SUs on Beer’s Criteria?
What is the recommendation?
If we really need to use SUs, which specific SUs should we choose and why?
- Higher risk of CV events like CV death and ischemic stroke
- Higher risk of hypoglycemia
- Avoid SUs as first/ second-line monoTx or add-on Tx
- If really need to use, choose short-acting agents (glipizide) over long-ating agents (glyburide, glimepride)
Rationale for PPIs on Beer’s Criteria?
What is the recommendation? (avoid use for how long and in high risk pts- what constitutes high risk?)
Give some examples
- Risk of C.diff infections, pneumonia, GI malignancies, bone loss, fractures
- Avoid use for >8w unless for high risk pts (oral corticosteroids, chronic NSAID use)
Examples: omeprazole, esomeprazole
Rationale for metoclopramide on Beer’s Criteria?
- Causes EPSE SEs
Rationale for GI antispasmodics on Beer’s Criteria?
Give some examples
- Highly anticholinergic, avoid
Examples: scopolamine, hyoscyamine, atropine
