explicit criteria Flashcards
BEERS for potentially inappropriate medication use in older adults.
(CVS)
aspirin, warfarin, rivaroxaban
dipyridamole
non-selective a1 blockers
nifedipine
amiodarone, dronedarone, digoxin
BEERS for potentially inappropriate medication use in older adults.
(antihistamines, anti infectives)
first gen antihistamines (anticholinergic effects)
nitrofurantoin (pul toxicity, hepatotoxicity)
BEERS for potentially inappropriate medication use in older adults.
(CNS)
antidep (strong antichol)
antiparkinsonian (strong antichol)
antipsychotics (1st, 2nd gen)
barbiturates
BZP
Z drugs
ergoloid
BEERS for potentially inappropriate medication use in older adults.
(endocrine)
androgens
estrogens (w/o prog)
insulin (without basal)
sulfonylurea
growth hormone
BEERS for potentially inappropriate medication use in older adults.
(GI; genitourinary)
PPI
metoclopramide
antispasmodics (w/ antichol)
genitourinary: Desmopressin
BEERS for potentially inappropriate medication use in older adults.
pain
non-selective
skeletal muscle relaxants
Potentially inappropriate medication use in older adults due to drug–disease or drug-syndrome interactions that may exacerbate the disease or syndrome
(HF)
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
Potentially inappropriate medication use in older adults due to drug–disease or drug-syndrome interactions that may exacerbate the disease or syndrome
(syncope)
incr risk of OH:
- Antipsychotics (chlorpromazin, olanzapine)
- tertiary TCAs (ami, clomipramine, imipramine)
- Non-selective peripheral alpha-1 blockers
bradycardia
- Anticholinesterase inhibitors (donepezil, galantamine, rivastigmine)
Potentially inappropriate medication use in older adults due to drug–disease or drug-syndrome interactions that may exacerbate the disease or syndrome
(delirium)
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
Potentially inappropriate medication use in older adults due to drug–disease or drug-syndrome interactions that may exacerbate the disease or syndrome
(dementia)
- anticholinergics
- APS (only BPSD harm to self/others)
- BZP
- Z drugs
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, #)
- anticholinergics
- antidep (SSRI, SNRI, TCA)
- antiepileptics
- BZP, z-drugs
- APS
- opioids
Potentially inappropriate medication use in older adults due to drug–disease or drug-syndrome interactions that may exacerbate the disease or syndrome
(parkinson disease)
- antiemetics (dopamine receptor antagonist -metoclop, prochlorperazine, promethazine)
- APS (except clozapine, quetiapine, pimavansern less likely to worsen PD)
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)
- aspirin
- non selective NSAID (avoid unless no alt, use with PPI, misoprostol)
Potentially inappropriate medication use in older adults due to drug–disease or drug-syndrome interactions that may exacerbate the disease or syndrome
(UI; LUTS)
- non slective peripheral a1 blocker
- estrogen (PO, TD…. not intravag)
LUTS
- strong anticholinergics (except antimuscarinics for UUI: oxybutynin, tolterodine, solifenacin)
potentially inappropriate medications: drugs to be used with caution in
older adults
- 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)
potentially clinically important drug–drug interactions that should be avoided in older adults.
- 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
adjust for kidney function
<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
HAM
adrenergic agonist, antagonist
antiarrhythmia
antithrombotics
chemo
dialysis sol
insulin
liposomal forms of drugs (amp B)
opioids
hypoglycemics
STOPPFALL
- 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)
mechanism associated with dizziness
- hypotension, postural hypoten, TDP, arrhythmia
- central anticholinergic effect
- cerebullar toxicity
- hypogly
- ototoxicity
- bleeding complication, bone marrow suppression (antiTHY)
- hypotension, postural hypoten, TDP, arrhythmia
alcohol, class 1a, antiepileptic, antihistamine
antiHTN, anti-infectives, antiparkinson, digoxin, narcotics
nitrates
PDE5i, SGLT2i, urinary anticholinergics
- central anticholinergic effect
skeletal muscle relaxant
urinary and GI antispasmodics
- cerebullar toxicity
antiepileptics
BZP
Li
hypogly
antiDM
beta-adrenergic blockers
ototoxicity
aminoglycosides
hydroxychloroquine
anti rhuematic
bleeding comp/ bone marrow supp
anticoag
antithyroid
delirium medications
- 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
drugs that can worsen UI [less bladder contraction]
- 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
Drugs that can worsen UI [tighten urethral duct]
- 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!
