Beers criteira Flashcards
what classes medications should be avoided for their anticholinergic side effects?
and what is the recommendation
antihistamines (first generation)
antidepressants (in particular TCA and paroxetine)
skeletal muscle relexants (eg orphenadrine)
AVOID
(additional: antipsychotics like clozapine and olanzapine)
what classes medications should be avoided for their sedating side effects?
and what is the recommendation
antidepressants (in particular TCA and paroxetine)
skeletal muscle relexants (eg orphenadrine)
benzodiazepines
AVOID
what classes medications should be avoided for their bleeding side effects?
and what is the recommendation
aspirin (if primary prevention)
warfarin (VTE, SPAF) unless c/I DOAC
rivaroxaban (VTE, SPAF) = higher risk of bleeding compared to other DOACs
for warfarin and aspirin - avoid starting
for rivaroxaban = avoid long term treatment
what classes medications should be avoided for their OH side effects?
and what is the recommendation
non selective alpha1 blockers
antidepressant (tca)
dipyridamole (not really used in sg)
AVOID non-selective alpha 1 as antihypertensive (BPH okay?)
when should antipsychotics (FGA, SGA) be deprescribed in elderly
BPSD in dementia
increased risk of MACE (mortality and stroke)
when to avoid benzodiazepines and why
continued use
= may lead to physical dependence, cognitive impairment (falls, delirium, fractures)
may only be appropriate for seizure, BZP withdrawal, ethanol withdrawal, GAD, sleep disorders.
when to avoid nitrofurantoin and why
crcl < 30 or long term suppression
RISK of pulmonary toxicity, hepatotoxicity, peripheral toxicity
when to avoid barbiturates and why (also list them)
phenobarbital
high rate of physical dependence, tolerance to sleep benefits, risk of overdose.
recommendations for estrogen with or without progestin
high risk of carcinogenic potential (breast and endometrial cancer) in older women starting HRT
do not initiate systemic estrogen (oral tab, transdermal patches)
deprescribe among older women
INSULIN recommendations
avoid short or rapid acting without concurrent use of basal or long acting
sulfonylurea recco
high risk of CV, mortality and hypoglucaemia
- avoid as mono therapy or add on unless c/I
choose short acting (if su really needed) eg glipizide over longer acting (glimepiride, glyburide)
ppi recommendations
risk of cdad, pneumonia, gi malignancy, bone loss/fracture
avoid use for >8 weeks unless high risk (chronic NSAID, GC) or GI conditions (Barretts, erosive esophagitis)
metoclopramide recommendations
avoid unless for gastroparesis (no more than 12 wks)
risk of EPSE incl tardive dyskinesia
nsaids recommendations
avoid non selective
- chronic use (unless no alternatives or patient can take ppi)
avoid combination with GC, anticoagulants, anti platelets
drugs to avoid with HF
avoid in HFREF - NDHP CCB (diltiazem, verapamil)
caution: nsaids, dronedarone, pioglitazone
drugs to avoid with syncope
antipsychotics (olanzapine)
achei (if syncope caused by SE bradycardia)
non selective alpha antagonist
TCA
drugs to avoid with delirum (high risk or current)
anticholinergic
antipsych (BPSD = avoid)
bzp
gc (only use lowest possible dose, shortest duration)
h2ra
opioids (risk vs benefit)
GC may stimulate cortisol and bind to the brain, H2RA may bind to histamine receptors in the brain
drugs to avoid if PMH falls
anticholinergic
antidepressants incl SSRI SNRI
AEM
antipsych
BZP
Opioids
unless no safer alternatives
AEMs induce ataxia and other cognitive side effects like dizziness and drowsiness causing increased fall risk
drugs to avoid with PD
antiemetics - metoclopramide, prochloperazine, promethazine
antipsychotics - except clozapinem quetiapine
drugs to avoid with UI
non selective alpha blocker (aggravate)
estogen (lack of efficacy)
what to avoid with opioid
bzp = increase dose and se
gabapentin/pregabalin = increase risk of severe sedation, respiratory depression
what to avoid with anticholinergics
add on more than 1 other anticholinergic agent
- increases risk of delirum, cognitive decline, falls and fractures
concerns with cns active drugs
≥3 of these drugs increases fall and fracture risk
- AEM, antidepressants, antipsych, BZP, opioids, skeletal muscle relaxants
what to avoid with lithium
acei, arb, arni,
loop
- lithium toxicity
avoid and monitor lithium conc
what to avoid with non selective alpha 1 blockers
loop diuretics
increased UI risk
what to avoid with phenytoin
BACTRIM
increase risk of phenytoin toxicity
considerations for warfarin
amiodarone
cipro
macrolides
bactrim
ssri
increases risk of bleeding,
avoid when possible
if combined then monitor iNR closely
