Beers Criteria Flashcards
What are the Classes/Medications that are in the beers list?
Anticholinergic Dicyclomine Nitrofurantoin Peripheral alpha-1 blockers Clinidine Dig Nifedipine (IR) Amiodarone Antidepressants Antipsychotics Benzos Non-benzo benzo receptor agonist hypontics Estrogen w/ or w/o progestins Insulin, sliding scale Megestrol Sulfonylureas, long duration PPIs Meperidine Non-cyclooxygenase-selective NSAIDs Indomethacin/ketorolax Skeletal muscle relaxants
What is the rationale for anticholinergics being on the beers list?
Clearance reduced with advanced age, risk of confusion, constipation, etc.
Tolerance develops when used as hypnotic
What is the rationale for dicyclomine being on the beers list?
Highly anticholinergic
What is the rationale for nitrofurantoin being on the beers list?
Risk pulmonary toxicity, hepatitis, peripheral neuropathy especially with long term use. Safer alternatives available
What is the rationale for peripheral alpha-1 blockers being on the beers list?
High risk of orthostatic hypotension, not recommended as routine treatment for HTN; alternative agents have superior risk-benefit profile
What is the rationale for clonidine being on the beers list?
High risk of ADR CNS effects
May cause bradycardia and orthostatic hypotension
What is the rationale for digoxin being on the beers list?
May be associated with increased mortality
Questionable effects of risk on hospitalization in those with HF, may be associated with increased mortality. Higher doses not associated with more benefit - may increase toxicity
Decreased renal clearance = toxicity
What is the rationale for nifedipine being on the beers list?
Risk for hypotension and myocardial ischemia
What is the rationale for antidepressants being on the beers list?
Highly anticholinergic, sedation, risk of orthostatic hypotension
What is the rationale for amiodarone being on the beers list?
Effective, but toxicities are higher than for other antiarrhythmics
What is the rationale for antipsychotics being on the beers list?
Increased risk of stroke and greater cognitive decline and mortality in those with dementia
What is the rationale for benzos being on the beers list?
Increased sensitivity, decreased metabolism of long-acting agents; in general all BZDs increase risk of cognitive impairment, delirium, falls, fractures, and MVA in older adults
May be appropriate for seizure disorders, rapid eye movement sleep disorders, BZD, or EtOH withdrawal, severe GAD, and periprocedurally
What is the rationale for non-benzo benzo being on the beers list?
Similar risk to benzos
Minimal improvement in sleep latency and duration
What are non-benzo benzos?
Ambien
Lunesta
Zaleplon
What is the rationale for estrogen w/ or w/o progestin being on the beers list?
carcinogenic (breast, endometrial), lack of cardiac/cognitive protection in older women
Vaginal estrogens are for vaginal dryness are safe and effective
What is the rationale for sliding scale insulin being on the beers list?
High risk of hypoglycemia w/o improvement in hyperglycemia management regardless of care setting
What is the rationale for megestrol being on the beers list?
Minimal effect on weight, increased risk of thrombotic events and possibly death
What is the rationale for sulfonylureas being on the beers list?
Hypoglycemia
What is the rationale for PPIs being on the beers list?
Risk of C diff infection and bone loss/fractures
What is the rationale for meperidine being on the beers list?
Not effective in doses commonly used, may have higher neurotoxicity risk
Safer alternatives available
What is the rationale for non-COX-selective NSAIDs being on the beers list?
Increased risk of GI bleed or PUD in those aged > 75 years or taking corticosteroids, anticoagulants, or antiplatelet agents
Use of PPI or misoprostol reduces risk
Upper GI ulcers, bleeding, or perforation
Risk increases with duration of use
What is the rationale for Indomethacin/ketoralac being on the beers list?
More likely than other NSAIDs to have CNS effects
Higher risk of bleeding and AKI in older adults
What is the rationale for skeletal muscle relaxant being on the beers list?
Most poorly tolerated d/t anticholinergic ADRs, sedation, increased risk of fractures
Effectiveness at dosages tolerated by older adults questionable
Which of the beers list medications are recommended to be avoided regardless?
Anticholinergics Dicyclomine Antidepressants Benzos Nonbenzo benzo Insulin Sulfonylurea Indomethacin/ketoralac Skeletal muscle relaxant
When should elderly avoid nitrofurantoin?
CrCl < 30
When should elderly avoid peripheral alpha-1 blockers
As hypertensive
When should elderly avoid clonidine?
Routine treatment for HTN
When should elderly avoid dig?
1st line for AF
1st line for HF
If used, avoid doses > 0.125 mg/d
When can amiodarone be used in elderly?
as 1st line for those with AF and HF or LVH if rhythm control is preferred over rate control
When should elderly avoid antipsychotics?
For behavioral problems of dementia or delirium unless non-pharmacologic options have failed or are not possible AND the older adult is threatening substantial harm to self or others
For schizophrenia, bipolar disorder, short term use as an antiemetic during chemotherapy is reasonable
When should elderly avoid Estrogen w/ or w/o progestins
Oral and topical patch
Vaginal creams and tablets acceptable to use low dose
When should elderly avoid PPIs?
Avoid scheduled use for > 8 weeks unless high risk patient (oral corticosteroids/chronic NSAID use), erosive esophagitis, Barrett’s esophagus, pathological hypersecretory condition, or demonstrated need for maintenance treatment
When should elderly avoid meperidine?
Generally but especially those with CKD
When should elderly avoid Non-COX-selective NSAIDs?
Avoid chronic use, unless other alternatives are not effective and patient can take gastroprotective agent (PPI or misoprostol)
