Geriatric Medication Considerations Flashcards
ADRs in Old People
Consequence of inappropriate drug prescribing
Most drugs not tested on olds or babies
Big Study from 10 Years ago
90% of adults on one medication. 40% on 5 or more
Olds Meds Number in Nursing Home
Average of 14 meds
Polypharmacy
Use of multiple meds by a single patient
5+, 10+ 15+ meds.
Increases ADRs, drug interactions, problems with adherence
BEERS Criteria
Most widely used criteria to assess inappropriate drug prescribing
PIMS
Potentially Inappropriate Medications
5 Categories of PIMs
1 Potentially Inappropriate
2 Typically avoided in certain conditions
3 Use with caution
4 Clinically significant drug interactions
5 Drug dose adjustments based on kidney function
Nitrofurantoin
Anti-ineffective for UTIs, avoid in CrCl <30mL/min; risk of pulmonary toxicity
CV drugs
High risk of orthostatic hypotension; alpha 1blockers (doxazosin, prazosin, terazosin) and central agonists (Clonidine)
CNS agents
Benzos; increased sensitivity and decreased metabolism of long acting agents (diazepam)
GI agents
Metoclopramide; extrapyrimidal effects in long term use
PPIs; increased risk of C. diff and bone loss/fractures
Anticholinergic Agents
a/w multiple adverse effects
Cognitive: memory, confusion, hallucination
Somatic: Most common effects. Dry mouth, blurred vision, constipation, nausea, urine retention, tachyardia
Most significant: Amitriptyline, dicyclomine, doxepin, clozapine
Higher doses and additive effects of multiple agents is of particular concner
NSAIDS
Risk of GI bleeding. More common >75 years old.
Skeletal Muscle Relaxants
Combo of anti-cholinergic, sedation, risk of falls
Heart Failure
Avoid NSAIDs, Thiazolidinediones, diltiazem and verapamil, dronedarone
All have potential to promote fluid retention and exacerbate heart failure
Chronic Seizures
Buproprion and tramadol. Can lower threshold
Delirium/dementia/cognitive impairment
Anticholinergics, antipsychotics, benzos, H2RAs.
Increased risk of CNS effects
Parkinsons
Antipsychotics. Precipitate PD s/s
Use with Caution
Aspirin; lacks benefit in pts over 80. Billy says its ok, especially if pt is in good health
Dabigatran: increased risk of GI bleed, especially over 75
Vasodilators: increased risk of syncope(hydralazine and nitro)
