Beers Criteria

Question 1

Nitrofurantoin

Answer 1

Potential for pulmonary toxicity, hepatotoxicity, peripheral neuropathy -> avoid in CrCl <30 or for long-term suppression

Question 2

Peripheral alpha-1 blockers for tx of HTN (doxazosin, prazosin, terazosin)

Answer 2

Risk of orthostasis -> avoid use

Question 3

Central alpha-agonists

Answer 3

Avoid as first-line

Question 4

Clonidine for first-line HTN, guanabenz, guanfacine, methyldopa, reserpine >0.1 mg/day

Answer 4

High risk of CNS AEs, bradycardia, orthostasis -> avoid

Question 5

Digoxin for first-line of afib of HF

Answer 5

Safer and more effective options -> avoid use, especially doses >0.125 mg/day

Question 6

Nifedipine

Answer 6

Potential for hypotension, risk of precipitating myocardial ischemia -> avoid

Question 7

Antidepressants (amitriptyline, amoxapine, clomipramine, desipramine, doxepin >6 mg/day, imipramine, nortriptyline, paroxetine, protriptyline, trimipramine)

Answer 7

Highly anticholinergic, sedating, orthostasis -> avoid

Question 8

Antipsychotics

Answer 8

Increased risk of stroke, cognitive decline, and mortality in dementia -> avoid except for schizophrenia, bipolar, or short-term antiemetic

Question 9

Benzodiazepines

Answer 9

Decreased metabolism of long-acting agents, increased risk of cognitive impairment, delirium, falls, fractures, and MVC -> avoid except in seizure, REM sleep behavior disorder, benzo or alcohol withdrawal, GAD, or anesthesia

Question 10

Meprobamate

Answer 10

High rate of physical dependence, sedating -> avoid

Question 11

Z hypnotics

Answer 11

Delirium, falls, fractures, increased ER visits, hospitalizations, MVC -> avoid

Question 12

Megestrol

Answer 12

Minimal effect on weight, risk of thrombotic events and death -> avoid

Question 13

Long-acting sulfonylureas (chlorpropamide, glimepiride, glyburide)

Answer 13

Prolonged hypoglycemia, SIADH -> avoid

Question 14

Metoclopramide

Answer 14

EPS, tardive dyskinesia -> avoid unless gastroparesis and not >12 weeks

Question 15

PO Mineral oil

Answer 15

Aspiration and AEs -> avoid

Question 16

PPIs

Answer 16

Risk of C. diff, bone loss, fractures -> avoid for >8 weeks unless high risk

Question 17

Skeletal muscle relaxants (carisoprodol, chlorzoxazone, cyclobenzaprine, metaxalone, methocarbamol, orphenadrine)

Answer 17

Anticholinergic AEs, sedation, risk of fractures -> avoid

Question 18

Syncope with AChEIs, nonselective peripheral alpha-1 blockers, tertiary TCAs, antipsychotics (chlorpromazine, thioridazine, olanzapine)

Answer 18

Bradycardia, orthostasis -> avoid

Question 19

Hx of falls or fractures with antiepileptics, antipsychotics, benzos, z hypnotics (eszopiclone, zaleplon, zolpidem), antidepressants (TCAs, SSRIs, SNRIs), opioids

Answer 19

May cause ataxia, impaired psychomotor function, syncope, falls -> avoid if possible except antiepileptics in seizure or mood disorders or opioids in severe acute pain

Question 20

Aspirin for primary prevention of CVD and colorectal cancer

Answer 20

Risk of bleed, lack of benefit in primary prevention -> caution in >70yo

Question 21

Dabigatran, Rivaroxaban

Answer 21

Increased risk of GI bleed compared to warfarin in tx of VTE or afib -> use with caution in >75yo

Question 22

Prasugrel

Answer 22

Increased risk of bleed, except when ACS managed with PCI -> use with caution in >75yo

Question 23

Antipsychotics, carbamazepine, diuretics, mirtazapine, oxcarbazepine, SNRIs, SSRIs, TCAs, tramadol

Answer 23

May exacerbate or cause SIADH or hyponatremia -> use with caution

Question 24

Dextromethorphan/quinidine

Answer 24

Limited efficacy in pts with behavioral sx of dementia, may increase risk of falls and DI -> use with caution

Question 25

Bactrim

Answer 25

Increased risk of hyperkalemia when used with ACE/ARB and decreased CrCl -> use with caution