BEERS Criteria - CVS Flashcards
What are the 4 HTN drugs to avoid in the BEERS Criteria? Include the rationale why
Dipyridamole (oral short-acting), non-selective peripheral α1-blockers (prazosin, terazosin): may cause orthostatic hypotension, more effective alternative available
Central α-agonists (clonidine, guanfacine): high risk of CNS effects, may cause bradycardia and orthostatic hypotension
Nifedipine (IR): potential for hypotension, risk of precipitating angina and myocardial ischemia
What are the recommendations regarding the use of antithrombotics?
Aspirin: avoid initiating / deprescribe for primary prevention
Warfarin: avoid unless DOACs are C/I or warfarin has been used long term + INR is well-controlled (i.e. >70% time in the therapeutic range) and no adverse effects
Rivaroxaban (long-term tx of non-valvular AF or VTE): avoid
Warfarin: higher risk of bleeding compared to DOACs
Rivaroxaban: higher risk of major bleeding and GI bleed than other DOACs (apixaban)
________ should be avoided in syncope patients as it can cause bradycardia
Donepezil, rivastigmine, galantamine
What drugs should be avoided in patients with HF, and why?
Non-DHP CCBs (diltiazem, verapamil): avoid in HFrEF
Dronedarone, NSAIDs, COX2i, thiazolidinediones: avoid in pts with symptomatic HF
These drugs have the potential to promote fluid retention and/or exacerbate HF
Recap on some drugs that causes orthostatic hypotension
- Non-selective α1-blockers (prazosin, terazosin)
- Anticholinergics (antipsychotics, TCAs, antidepressants, muscle relaxants, antiparkinsonians, 1st gen antihistamines)
List drugs that have DDIs with warfarin. What is the risk rationale and recommendations?
Drugs with DDIs: amiodarone, ciprofloxacin, macrolides (excluding azithromycin), bactrim, SSRIs
Risk rationale: increased risk of bleeding
Recommendations: avoid if possible, monitor INR closely
The use of non-selective α-1 blockers with loop diuretics causes _________ in older ________. Recommendation is to avoid in older _____, unless condition warrants both drugs.
Increased risk of urinary incontinence in older women
The use of lithium with ACEis, ARBs, ARNIs, or loop diuretics causes _________. Recommendation is to avoid and monitor ________.
Increased risk of lithium toxicity
Monitor lithium concentrations
What are the renal dose adjustments listed for Dabigatran and Rivaroxaban?
Dabigatran
* avoid when CrCl<30
* lack of evidence of efficacy and safety
Rivaroxaban
* dose reduction when CrCL<50
* avoid when CrCl<15
* lack of evidence of efficacy or safety
What is the renal dose adjustment listed for spironolactone
Avoid when CrCl<30
Hyperkalemia
