Beers Criteria

Question 1

Amitriptyline
Amoxapine
Clomipramine
Desipramine
Doxepin (>6 mg/day)
Imipramine
Nortriptyline
Paroxetine
- Prochlorperazine
- Promethazine
Brompheniramine
Chlorpheniramine
Cyproheptadine
Dimenhydrinate
Diphenhydramine
Doxylamine
Hydroxyzine
Meclizine
Promethazine
Triprolidine
- Darifenacin
- Fesoterodine
- Flavoxate
- Oxybutynin
- Solifenacin
- Tolterodine
- Trospium
Benztropine
Trihexyphenidyl
- Chlorpromazine
- Clozapine
- Olanzapine
- Perphenazine
Atropine
Clidinium-chlordiazepoxide
Dicyclomine
Homatropine
Hyoscyamine
Scopolamine
- Cyclobenzaprine
- Orphenadrine
should be avoided in pts w hx of:

Answer 1

falls and fractures, dementia or cognitive impairment

LUTS/BPH: except Darifenacin
Fesoterodine
Flavoxate
Oxybutynin
Solifenacin
Tolterodine
Trospium

Question 2

When may benzos be appropriate?

Answer 2

in seizure disorder, alcohol or benzo withdrawal, severe anxiety, or periprocedural anesthia

Question 3

why is eszopiclone a PIM?

Answer 3

(Z drug)
- there is risk of dependence
- with opioids there is excess sedation risk
- older adults have higher sensitivity, increased risk of falls, delirium, cognitive impairment

Question 4

Why are benzos a PIM?

Answer 4

• there is risk of dependence
• with opioids there is excess sedation risk
• older adults have higher sensitivity, increased risk of falls, delirium, cognitive impairment

Question 5

why are NSAIDs a PIM?

Answer 5

increased risk of GI bleed and PUD; avoid short term use with corticosteriods, anticoag, or antiplatelets

Question 6

why is zaleplon a PIM?

Answer 6

(Z drug)
- there is risk of dependence
- with opioids there is excess sedation risk
- older adults have higher sensitivity, increased risk of falls, delirium, cognitive impairment

Question 7

why are PPIs PIMs?

Answer 7

increased risk of C diff, pneumonia, GI malignancy, and bone loss; avoid scheduled use for 8+ weeks unless chronic NSAID use, Barrett’s esophagus, or demonstrated need

Question 8

why are antipsychotics a PIM?

Answer 8

increased risk of stroke, cognitive decline, death with dementia

Question 9

Keppra, phenytoin, valproate, lamotrigine, topiramate should be avoided in pts w hx of:

Answer 9

falls or fractures; except w hx of seizures and mood disorders

Question 10

When might antipsychotics be appropriate?

Answer 10

for schizophrenia, bipolar, parkinson’s, or depression adjunct

Question 11

SNRIs, SSRIs, and TCAs should be avoided in pts w hx of:

Answer 11

falls or fractures

Question 12

antipsychotics should be avoided in pts w hx of:

Answer 12

falls or fractures, dementia or cognitive impairment

• increased stroke, death, and cognitive decline in dementia pts, avoid unless nonpharm has failed and theres harm to no treatment

Question 13

when are NSAIDs potentially appropriate?

Answer 13

• chronic use should be avoided unless other agents are not effective – take w a PPI

Question 14

why is zolepidem a PIM?

Answer 14

(Z drug)
- there is risk of dependence
- with opioids there is excess sedation risk
- older adults have higher sensitivity, increased risk of falls, delirium, cognitive impairment

Question 15

Why is
- Amitriptyline
- Amoxapine
- Clomipramine
- Desipramine
- Doxepin (>6 mg/day)
- Imipramine
- Nortriptyline
- Paroxetine
a PIM?

Answer 15

anticholinergic, sedating, can cause orthostatic hypotension.

low dose doxepin is ok

Question 16

benzodiazepines should be avoided in pts w hx of:

Answer 16

falls or fractures, dementia or cognitive impairment

Question 17

zaleplon, eszopiclone, zolpidem should be avoided in pts w hx of:

Answer 17

falls or fractures, dementia or cognitive impairment

Question 18

Doxazosin, Prazosin, Terazosin, and estrogens (except intravaginal estrogen) should be avoided in pts w hx of:

Answer 18

urinary incontinence

Question 19

opioids should be avoided in pts w hx of:

Answer 19

falls or fractures (except for severe pain)

Question 20

alcohol cause why type of incontinence?

Answer 20

urge: polyuria resulting in urinary frequency

Question 21

diuretics cause why type of incontinence?

Answer 21

urge: polyuria resulting in urinary frequency

Question 22

alpha-antagonists (doxazosin, terazosin, prazosin) cause why type of incontinence?

Answer 22

stress: causes reduced urethral sphincter closure and urinary retention (anticholinergic effects of reduced bladder contractility)

Question 23

ACE inhibitors cause why type of incontinence?

Answer 23

stress: only if pt has symptom of cough

Question 24

TCAs cause why type of incontinence?

Answer 24

stress - (alpha antagonism effects; reduced urethral sphincter closure) and urinary retention (anticholinergic effects of reduced bladder contractility)

Question 25

sedatives cause why type of incontinence?

Answer 25

functional - delirium and immobility

Question 26

anticholinergics cause why type of incontinence?

Answer 26

urinary retention - reduced bladder contractility

Question 27

acetylcholinesterase inhibitors (rivastigmine, donepezil, galantamine) cause why type of incontinence?

Answer 27

urge : polyuria resulting in urinary frequency

Question 28

narcotics cause why type of incontinence?

Answer 28

urinary retention - reduced bladder contractility

Question 29

calcium channel blockers cause why type of incontinence?

Answer 29

urinary retention - reduced bladder contractility

Question 30

antipsychotics cause why type of incontinence?

Answer 30

urinary retention - reduced bladder contractility

Question 31

alpha-agonists (pseudoephedrine, ephedrine, phenylephrine) cause why type of incontinence?

Answer 31

increased urethral sphincter closure force causes urinary retention

Question 32

Medications that make ed worse?

Answer 32

Anticholinergics, estrogens, cns depressants (benzos, opioids, anti-epileptics), diuretics (decrease penile flow), dopamine agonists

Question 33

Medications that can cause delirium?

Answer 33

Anticholinergics, benzos, corticosteroids, opioids, antipsychotics, h2 antagonists, z drugs