Beers Criteria Flashcards
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:
falls and fractures, dementia or cognitive impairment
LUTS/BPH: except Darifenacin
Fesoterodine
Flavoxate
Oxybutynin
Solifenacin
Tolterodine
Trospium
When may benzos be appropriate?
in seizure disorder, alcohol or benzo withdrawal, severe anxiety, or periprocedural anesthia
why is eszopiclone a PIM?
(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
Why are benzos a PIM?
- there is risk of dependence
- with opioids there is excess sedation risk
- older adults have higher sensitivity, increased risk of falls, delirium, cognitive impairment
why are NSAIDs a PIM?
increased risk of GI bleed and PUD; avoid short term use with corticosteriods, anticoag, or antiplatelets
why is zaleplon a PIM?
(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
why are PPIs PIMs?
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
why are antipsychotics a PIM?
increased risk of stroke, cognitive decline, death with dementia
Keppra, phenytoin, valproate, lamotrigine, topiramate should be avoided in pts w hx of:
falls or fractures; except w hx of seizures and mood disorders
When might antipsychotics be appropriate?
for schizophrenia, bipolar, parkinson’s, or depression adjunct
SNRIs, SSRIs, and TCAs should be avoided in pts w hx of:
falls or fractures
antipsychotics should be avoided in pts w hx of:
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
when are NSAIDs potentially appropriate?
- chronic use should be avoided unless other agents are not effective – take w a PPI
why is zolepidem a PIM?
(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
Why is
- Amitriptyline
- Amoxapine
- Clomipramine
- Desipramine
- Doxepin (>6 mg/day)
- Imipramine
- Nortriptyline
- Paroxetine
a PIM?
anticholinergic, sedating, can cause orthostatic hypotension.
low dose doxepin is ok
benzodiazepines should be avoided in pts w hx of:
falls or fractures, dementia or cognitive impairment
zaleplon, eszopiclone, zolpidem should be avoided in pts w hx of:
falls or fractures, dementia or cognitive impairment
Doxazosin, Prazosin, Terazosin, and estrogens (except intravaginal estrogen) should be avoided in pts w hx of:
urinary incontinence
opioids should be avoided in pts w hx of:
falls or fractures (except for severe pain)
alcohol cause why type of incontinence?
urge: polyuria resulting in urinary frequency
diuretics cause why type of incontinence?
urge: polyuria resulting in urinary frequency
alpha-antagonists (doxazosin, terazosin, prazosin) cause why type of incontinence?
stress: causes reduced urethral sphincter closure and urinary retention (anticholinergic effects of reduced bladder contractility)
ACE inhibitors cause why type of incontinence?
stress: only if pt has symptom of cough
TCAs cause why type of incontinence?
stress - (alpha antagonism effects; reduced urethral sphincter closure) and urinary retention (anticholinergic effects of reduced bladder contractility)
sedatives cause why type of incontinence?
functional - delirium and immobility
anticholinergics cause why type of incontinence?
urinary retention - reduced bladder contractility
acetylcholinesterase inhibitors (rivastigmine, donepezil, galantamine) cause why type of incontinence?
urge : polyuria resulting in urinary frequency
narcotics cause why type of incontinence?
urinary retention - reduced bladder contractility
calcium channel blockers cause why type of incontinence?
urinary retention - reduced bladder contractility
antipsychotics cause why type of incontinence?
urinary retention - reduced bladder contractility
alpha-agonists (pseudoephedrine, ephedrine, phenylephrine) cause why type of incontinence?
increased urethral sphincter closure force causes urinary retention
Medications that make ed worse?
Anticholinergics, estrogens, cns depressants (benzos, opioids, anti-epileptics), diuretics (decrease penile flow), dopamine agonists
Medications that can cause delirium?
Anticholinergics, benzos, corticosteroids, opioids, antipsychotics, h2 antagonists, z drugs
