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PR4152 > explicit criteria > Flashcards

explicit criteria Flashcards

1
Q

BEERS for potentially inappropriate medication use in older adults.

(CVS)

A

aspirin, warfarin, rivaroxaban

dipyridamole

non-selective a1 blockers
nifedipine

amiodarone, dronedarone, digoxin

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2
Q

BEERS for potentially inappropriate medication use in older adults.

(antihistamines, anti infectives)

A

first gen antihistamines (anticholinergic effects)

nitrofurantoin (pul toxicity, hepatotoxicity)

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3
Q

BEERS for potentially inappropriate medication use in older adults.

(CNS)

A

antidep (strong antichol)
antiparkinsonian (strong antichol)
antipsychotics (1st, 2nd gen)
barbiturates
BZP
Z drugs
ergoloid

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4
Q

BEERS for potentially inappropriate medication use in older adults.

(endocrine)

A

androgens
estrogens (w/o prog)
insulin (without basal)
sulfonylurea
growth hormone

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5
Q

BEERS for potentially inappropriate medication use in older adults.

(GI; genitourinary)

A

PPI
metoclopramide
antispasmodics (w/ antichol)

genitourinary: Desmopressin

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6
Q

BEERS for potentially inappropriate medication use in older adults.

pain

A

non-selective
skeletal muscle relaxants

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7
Q

Potentially inappropriate medication use in older adults due to drug–disease or drug-syndrome interactions that may exacerbate the disease or syndrome

(HF)

A

Avoid in HFrEF:
Nondihydropyridine calcium
channel blockers (CCBs)

  • Diltiazem, Verapamil

Use with caution in patients with
heart failure who are asx // avoid in patients with sx heart failure:

  • Dronedarone
  • NSAIDs and COX-2 inhibitors
  • Thiazolidinediones
  • Pioglitazone
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8
Q

Potentially inappropriate medication use in older adults due to drug–disease or drug-syndrome interactions that may exacerbate the disease or syndrome

(syncope)

A

incr risk of OH:

  • Antipsychotics (chlorpromazin, olanzapine)
  • tertiary TCAs (ami, clomipramine, imipramine)
  • Non-selective peripheral alpha-1 blockers

bradycardia

  • Anticholinesterase inhibitors (donepezil, galantamine, rivastigmine)
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9
Q

Potentially inappropriate medication use in older adults due to drug–disease or drug-syndrome interactions that may exacerbate the disease or syndrome

(delirium)

A

avoid in older adults with or at high risk of delirium

  • anticholinergics
  • APS (for BPSD if non-pharm fail, harm to self/ others. deprescribe periodically)
  • H2RA
  • BZP,Z drugs
  • CS
  • opioids
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10
Q

Potentially inappropriate medication use in older adults due to drug–disease or drug-syndrome interactions that may exacerbate the disease or syndrome

(dementia)

A
  • anticholinergics
  • APS (only BPSD harm to self/others)
  • BZP
  • Z drugs
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11
Q

Potentially inappropriate medication use in older adults due to drug–disease or drug-syndrome interactions that may exacerbate the disease or syndrome

(hx of falls, #)

A
  • anticholinergics
  • antidep (SSRI, SNRI, TCA)
  • antiepileptics
  • BZP, z-drugs
  • APS
  • opioids
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12
Q

Potentially inappropriate medication use in older adults due to drug–disease or drug-syndrome interactions that may exacerbate the disease or syndrome

(parkinson disease)

A
  • antiemetics (dopamine receptor antagonist -metoclop, prochlorperazine, promethazine)
  • APS (except clozapine, quetiapine, pimavansern less likely to worsen PD)
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13
Q

Potentially inappropriate medication use in older adults due to drug–disease or drug-syndrome interactions that may exacerbate the disease or syndrome

(hx of GI ulcers)

A
  • aspirin
  • non selective NSAID (avoid unless no alt, use with PPI, misoprostol)
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14
Q

Potentially inappropriate medication use in older adults due to drug–disease or drug-syndrome interactions that may exacerbate the disease or syndrome

(UI; LUTS)

A
  • non slective peripheral a1 blocker
  • estrogen (PO, TD…. not intravag)

LUTS

  • strong anticholinergics (except antimuscarinics for UUI: oxybutynin, tolterodine, solifenacin)
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15
Q

potentially inappropriate medications: drugs to be used with caution in
older adults

A
  • dabigatran (GI bleed)
  • tica, prasugrel (major bleed > clopi)
  • antidep (mirt, SNRI, SSRI, TCA) SIADH
  • antiepileptics (CBP, oxcarbazepine), APS, diuretics, tramadol (SIADH)
  • TMP-SMX (hyperK w/ renal w/ ACE/ARB)
  • SGLT2i (UTI, euglycemi diabetic ketoacidosis)
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16
Q

potentially clinically important drug–drug interactions that should be avoided in older adults.

A
  • ACEi + ARB / K-sparing/ ARNi
  • opioids + BZP/ gabapentin, pregabalin
  • antichol + antichol
  • antiepileptic, antidep, APS, BZP, z drug, opioids, skeletal muscle relaxant (combi of ≥3 drugs)
  • Li + ACEi/ loop (STAND)
  • non selective a blocker + loop (in F)
  • PT + TMP-SMX
  • theophylline + cimetidine/ cipro
  • warfarin + amiodarone/ cipro/ macrolides/ TMP-SMX/ SSRI
17
Q

adjust for kidney function

A

<30
rosuvastatin, THIAZIDE, METFORMIN, cipro, NTF, TMP-SMX, amiloride, dabigatran, enoxaparin, spironolactone, duloxetine, NSAID, tramadol, colchicine, probenecid

<50
rivaroxaban, cimetidine, famo

<40
lisinopril

<60
baclofen, GP, pregabalin

<80
levetiracetam

18
Q

HAM

A

adrenergic agonist, antagonist
antiarrhythmia
antithrombotics

chemo
dialysis sol

insulin
liposomal forms of drugs (amp B)
opioids
hypoglycemics

19
Q

STOPPFALL

A
  • BZP (sedation, cognitive impair)
  • APS (EPSE, cardiac SE)
  • OPIOIDS (slow reaction, impaired balance, sedative)
  • ANTIDEP (hypoNa, OH, dizzy, sedative, tacchy)
  • AntiEPILEPTICS (ataxia, somnolence, impaired balance, ddizy)
  • DIURETICS (OH, hypoTen, electrolyte disturbances, UI)
  • A BLOCKER (HTN, BPH) – (hypoTEN, OH, dizzy)
  • ANTIHISTAMINES (confusion, drowsy, dizzy, blurred vision)
  • VASODIL for cardiac (hypoTEN, OH, dizzy)
  • overactive bladder, UI meds (dizzy, confusion, blurred vision, drowsy, incr QT)
20
Q

mechanism associated with dizziness

A
  • hypotension, postural hypoten, TDP, arrhythmia
  • central anticholinergic effect
  • cerebullar toxicity
  • hypogly
  • ototoxicity
  • bleeding complication, bone marrow suppression (antiTHY)
21
Q
  • hypotension, postural hypoten, TDP, arrhythmia
A

alcohol, class 1a, antiepileptic, antihistamine
antiHTN, anti-infectives, antiparkinson, digoxin, narcotics
nitrates
PDE5i, SGLT2i, urinary anticholinergics

22
Q
  • central anticholinergic effect
A

skeletal muscle relaxant
urinary and GI antispasmodics

23
Q
  • cerebullar toxicity
A

antiepileptics
BZP
Li

24
Q

hypogly

A

antiDM
beta-adrenergic blockers

25
Q

ototoxicity

A

aminoglycosides
hydroxychloroquine
anti rhuematic

26
Q

bleeding comp/ bone marrow supp

A

anticoag
antithyroid

27
Q

delirium medications

A
  • Strong anticholinergics
    ○ Muscle relaxants, diphenhydramine etc
    ○ Avoid use, unless SEVERE ALLERGIC REACTIONS
  • BZP, Z-drugs
    ○ Impair slow wave sleep
    ○ Do not withdraw abruptly if chronic use
  • Opioids (pethidine, meperidine!!)
    ○ Elderly, poor kidney function, accumulate pethidine toxic metabolite.
    § Attention to opioid naïve dosing for elderly
    ○ Consider paracetamol, regular bowel regimen
  • H2 RA
    ○ Famotidine least anticholinergic effect. But PPI preferred
  • Antimicrobial (FQ, cefepime)
    ○ Adjust dose esp for poor kidney function
  • Corticosteroids (severe psychosis effect)
  • Herbs (Atropa Belladonna extract)
  • Hypoglycemics
  • Anticonvulsants
    ○ Levetiracetam (titrate with kidney function)
  • Psychoactive agents (Lithium)
    ○ Too low (bipolar not controlled), too high (change in behaviour)
  • Antidepressants (mirtazapine/ SSRI/ TCAs)
  • CVS drugs (digoxin)
    ○ Adjust based on renal function.
    ○ SE: confusion, vision discoloration, arrhythmia
28
Q

drugs that can worsen UI [less bladder contraction]

A
  • Anticholinergics (1st gen): decr contractility
    ○ Antimuscarinics; spasmolytics; antiparkinson meds; TCA; Skeletal muscle relaxants
  • ACEi: chronic coughing (stress UI)+ decr contractility
  • a-blockers: decr urethral sphincter tone
  • Antiarrhythmic: decr contractility (LA effect on bladder mucosa; anticholinergic effect)
  • Antipsychotics (1st gen > 2nd): decr contractility (anticholinergic)
  • BZP: muscle relaxant effect
  • CCB: decr contractility and retention
    ○ Can cause peripheral oedema (reduce mobility)
    ○ Nocturnal polyuria due to selective dilation of arteries –> incr hydrostatic P in cap –> water to interstitial space –> no gravity at night, enter intravascular space –> excrete
29
Q

Drugs that can worsen UI [tighten urethral duct]

A
  • Decongestants (pseudo, phenyl): incr urethral sphincter tone
  • Opioids (affect those with risk factors): decr sensation of fullness + incr urethral sphincter tone
  • a-agonist: incr urethral sphincter tone
  • Diuretics: incr urine prod, incr contractility or rate of empty
  • Antidepressants (SNRI): incr urethral sphincter tone
  • APS incr urethral sphincter tone (a1 receptor agonist but mostly just causes OH)
  • Caffeine: incr contractility or rate of empty
    ○ Diuretic and irritant!

PR4152 (8 decks)

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