drugs Flashcards
Meperidine
Brand name(s): Demerol, Meperitab Indication: For tx of anesthesia, obstetric pain, moderate-severe pain, premedication for a procedure Reason(s) for inclusion in the Beers Criteria: May have higher risk of neurotoxicity including delerium than other opioids
Piroxicam
Brand name(s): Feldene
Indication: Osteoarthritis; rheumatoid arthritis
Reason(s) for inclusion in the Beers Criteria: Increased risk of GI Bleeding or peptic ulcer disease in patients > 75 years old. Can also increase blood pressure and induce kidney injury.
. Pantoprazole
Brand name(s): Protonix
Indication: Tx of GERD, PUD, and H. Pylori
Reason(s) for inclusion in the Beers Criteria: Risk of Clostridium difficile infection and bone loss and fractures
Methyldopa
Brand name(s): Aldomet Indication: Treatment of high blood pressure Reason(s) for inclusion in the Beers Criteria: High risk of adverse CNS effects; may cause bradycardia and orthostatic hypotension; not recommended as routine treatment for hypertension
Clonidine
Brand name(s): Catapres, Catapres-TTS1, Catapres-TTS2, Kapvay Indication: Tx of hypertension Reason(s) for inclusion in the Beers Criteria: orthostatic hypotension, bradycardia, CNS adverse effects
Amitriptyline
Brand name(s): Elavil Indication: FDA Indication: Treatment of Depression Non-FDA Indication: Nerve Pain Reason(s) for inclusion in the Beers Criteria: Strong Anticholinergic Effects (e.g. confusion, cognitive impairment), Orthostatic Hypotension, and Sedation
Cyclobenzaprine
Brand name(s): Amrix, Fexmid, Flexeril Indication: For the treatment of muscle spasms associated with acute, painful musculoskeletal conditions. Reason(s) for inclusion in the Beers Criteria: Anticholinergic skeletal muscle relaxants are poorly tolerated in elderly patients. Cyclobenzaprine can cause sedation and weakness. The effectiveness at tolerated doses is uncertain. It is important to avoid use in older patients with delirium as it may cause or worsen delirium. Avoid use in patients with dementia and cognitive impairment because of adverse CNS effects. Avoid men with lower urinary tract symptoms or benign prostatic hyperplasia due to decreased urinary flow and urinary retention.
Ibuprofen
Brand name(s): Motrin, Advil, A-G Profen, Addaprin, Bufen, Genpril, Caldolor, Haltran
Indication: Cystic fibrosis, fever, headache, migraine, osteoarthritis, pain, primary dysmenorrhea, rheumatoid arthritis
Reason(s) for inclusion in the Beers Criteria: Ulcer, GI bleed, perforation risk, CNS effects, kidney injury, increased BP, worsening HF
Hydroxyzine
Brand name(s): Atarax Indication: Allergies (pruritus) Reason(s) for inclusion in the Beers Criteria: Avoid use due to its potent anticholinergic properties, resulting in increased risk of confusion, dry mouth, constipation, and other anticholinergic effects or toxicity; use should also be avoided due to reduced clearance with advanced age and tolerance associated with use as a hypnotic.
Diazepam
Brand name(s): Valium, Valtoco, Diastat Acudial
Indication: Tx of acute alcohol withdrawal, anxiety, muscle spasms, and seizures.
Reason(s) for inclusion in the Beers Criteria: Concerns with dependence, depression, prolonged sedation, confusion, falls, fractures, respiratory depression in COPD, incontinence
Older adults have increased sensitivity to benzodiazepines and decreased metabolism of long- acting agents; in general, all benzodiazepines increase risk of cognitive impairment, delirium, falls, fractures, and motor vehicle crashes in older adults
May be appropriate for seizure disorders, rapid eye movement sleep behavior disorder, benzodiazepine withdrawal, ethanol withdrawal, severe generalized anxiety disorder, and periprocedural anesthesia
Ketorolac
Brand name(s): Toradol Indication: Tx of pain, short-term Reason(s) for inclusion in the Beers Criteria: increased risk of GI bleed, PUD, AKI
Glyburide
Brand name(s): Diabeta Indication: Glyburide is indicated to improve glycemic control in adults with type 2 diabetes mellitus Reason(s) for inclusion in the Beers Criteria: Increased risk of severe prolonged hypoglycemia
Naproxen
Brand name(s): Naprosyn & EC-Naprosyn, Aleve
Indication: NSAID- Non-steroidal anti-inflammatory,
Mild to Moderate pain, primary dysmenorrhea, acute tendinitis, and bursitis (delayed-release tablets are not recommended for initial treatment of acute pain because the absorption of naproxen is delayed compared to absorption from other naproxen-containing products.): 500 mg initially followed by 250 mg every six to eight hours as needed.
Rheumatoid arthritis, osteoarthritis, and ankylosing spondylitis: 250 mg to 500 mg twice a clay.
Acute Gout: 750 mg initially followed by 250 mg eve1y eight hours until the attack is under control.
Reason(s) for inclusion in the Beers Criteria:
Increased risk of gastrointestinal bleeding or peptic ulcer disease in high-risk groups, including those>75yearsor taking oral or parenteral corticosteroids, anticoagulants, or antiplatelet agents; use of proton-pump inhibitor or misoprostol reduces but does not eliminate risk. Upper gastrointestinal ulcers, gross bleeding, or perforation caused by NSAIDs occur in ~1% of patients treated for 3-6 months and in~2%-4% of patients treated for 1 year; these trends continue with longer duration of use. Also, it can increase blood pressure and induce kidney injury. Risks are dose related.
Zolpidem
Brand name(s): Ambien Indication: insomnia Reason(s) for inclusion in the Beers Criteria: Increases fall risk, delirium, and fractures. Increases visits to the emergency room and car accidents.
Promethazine
Brand name(s): Phenergan, Promethegan, Prorex, Promacot, Phenadoz, Antinaus 50
Indication: Analgesic, allergic conjunctivitis, allergic reaction, allergic rhinitis, motion sickness, nausea, vomiting, post-operative pain, sedation, vasomotor rhinitis,
Reason(s) for inclusion in the Beers Criteria:
Avoid use in older adults due to strong anticholinergic effects and reduced clearance with advanced age; which increases the risk of anticholinergic effects and toxicity.
Tolerance develops when used as hypnotic.
Avoid use in elderly pts with Parkinson’s disease; those w/ or at risk for delirium, and in men w lower urinary tract symptoms or benign prostate hyperplasia as these conditions may worsen.
Zaleplon
Indication: Insomnia
Reason(s) for inclusion in the Beers Criteria:
Non-benzodiazepine benzodiazepine receptor agonist hypnotics (ie, Z drugs) have adverse events similar to those of benzodiazepines in older adults (eg, delirium, falls, fractures); increased emergency room visits/ hospitalizations; motor vehicle crashes; minimal improvement in sleep latency and duration (Moderate/ Strong)
Delirium
Avoid in older adults with or at high risk of delirium because of potential of inducing or worsening delirium (Moderate/Strong)
Dementia or Cognitive Impairment
Avoid because of adverse CNS effects (Moderate/Strong)
History of Falls or Fractures
May cause ataxia, impaired psychomotor function, syncope, additional falls; shorter acting benzodiazepines are not safer than long-acting ones. If one of the drugs must be used, consider reducing use of other CNS-active medications that increase risk of falls and fractures (ie, antiepileptics, opioid-receptor agonists, antipsychotics, antidepressants, nonbenzodiazepine and benzodiazepine receptor agonist hypnotics, other sedatives/hypnotics) and implement other strategies to reduce fall risk. (High/Strong)
Diphenhydramine
Brand name(s): Benadryl, Genahist, Sominex, Unisom, Nytol Indication: For the treatment of allergic conditions, cough, motion sickness, insomnia. Reason(s) for inclusion in the Beers Criteria: The rationale for diphenhydramine is that it’s highly anticholinergic and it’s clearance is reduced with advanced age, and tolerance develops when used as hypotonic which will make a risk of having confusion, dry mouth, constipation, or toxicity. Anticholinergic effects (e.g., confusion, cognitive impairment, delirium, dry mouth, constipation, urinary retention). Elimination reduced in elderly. Tolerance to hypnotic effect.
Doxylamine
Brand name(s): Unisom
Indication: Treatment of allergies
Treatment of short-term insomnia, reduce difficulty of falling asleep
Reason(s) for inclusion in the Beers Criteria: Highly anticholinergic; clearance reduced with advanced age and tolerance develops when used as a hypnotic
risk of confusion, dry mouth,cognitive impairment, constipation, urinary retention and other anticholinergic effects or toxicity
Terazosin
Brand name(s): Hytrin
Indication: For the treatment of Hypertension
For the treatment of BPH
Reason(s) for inclusion in the Beers Criteria: There is a high risk of orthostatic hypotension, not recommended for routine tx for hypertension, of special concern in pts with syncope, and women with urinary incontinence (especially when combined with a loop diuretic)
Carisoprodol
Brand name(s): Soma Indication: Muscle relaxant Reason(s) for inclusion in the Beers Criteria: Avoid in the elderly due to sedation and anticholinergic properties, which can promote delirium, sedation, and falls. Also increases risk of fractures. Effectiveness is questioned in older adults.
Nifedipine 💊 Immediate Release
Brand name(s): Procardia Indication: Hypertension, stable angina, variant angina, Raynaud’s phenomenon Reason(s) for inclusion in the Beers Criteria: potential for hypotension and risk of precipitating myocardial ischemia
Indomethacin
Brand name(s): Tivorbex, Indocin
Indication: For the moderate to severe arthritis, gouty arthritis, RA, mild to moderate pain, ankylosing spondylitis, osteoarthritis.
Reason(s) for inclusion in the Beers Criteria: Of all NSAIDs has the most ADEs, including CNS effects, more likely to cause GI bleeding, and peptic ulcers. It is both a COX 1 and COX 2
Phenobarbital
Brand name(s): Alepsal (AR, CR, DO, GT, HN, MX, NI, PA, SV); Andral (PH); Aparoxal (FR); Aphenylbarbit (CH); Barbee (IN); Barbilettae (FI); Barbiphenyl (FI); Bialminal (PT) Indication:Phenobarbital is used for sedation and for seizure especially management of generalized tonic-clonic, status epilepticus, and partial seizures. Reason(s) for inclusion in the Beers Criteria: High rate of physical dependence, tolerance to sleep benefits, greater risk of overdose at low dosages
Estradiol
Brand name(s): Estrace, Minivelle, Menostar Indication: Abnormal vasomotor function, atrophic vulva (moderate to severe), atrophy of vagina (moderate to severe), metastatic breast cancer, decreased estrogen level secondary to hypogonadism, dyspareeunia, menopause, postmenopausal osteoporosis, advanced androgen dependent prostate cancer Reason(s) for inclusion in the Beers Criteria: Evidence of carcinogenic potential (breast and endometrium), lack of cardioprotective effect and cognitive protection in older woman; evidence indicates that vaginal estrogens for the treatment of vaginal dryness are safe and effective
Methocarbamol
Brand name(s): Robaxin Indication: Tx of muscle spasms, musculoskeletal pain Reason(s) for inclusion in the Beers Criteria: is because of concerns of anticholinergic effects and questionable efficacy at dose tolerated in elderly, dosage is questionable
Thioridazine
Brand name(s): Mellaril Indication: Schizophrenia, Refractory Reason(s) for inclusion in the Beers Criteria: Causes bradycardia and orthostatic hypotension which increases the risk of falls
