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.
