Safe Medication Use Flashcards
PIMs
meds with risk that outweighs benefit in older patients
tools to identify PIMs
beers criteria, START/STOPP criteria, medication appropriateness index (MAI), anticholinergic risk scale (ARS)
2023 beers criteria PIM use in older adults drugs
antihistamines (-ine), nitrofurantoin, aspirin, warfarin, rivaroxaban, dipyridamole, doxazosin, clonidine, nifedipine, amiodarone, digoxin, antidepressants, antipsychotics, barbiturates, atropine, BZDs, z-drugs, androgens, estrogens, insulin, sulfonylureas, PPIs, metoclopramide, desmopressin, NSAIDs, indomethacin, ketorolac, meperidine, skeletal muscle relaxants
PIM classes to know
anticholinergics, BZDs, antidepressants, NSAIDs
anticholinergic side effects
blind as a bat, mad as a hatter, dry as a bone, hot as a hare, red as a beet, and the heart runs alone
anticholinergic examples
● TCAs (amitriptyline, nortriptyline, doxepin)
● antispasmodics (dicyclomine)
● antihistamines (diphenhydramine, hydroxyzine, promethazine)
● muscle relaxants (cyclobenzaprine, methocarbamol, oxybutynin)
anticholinergics and dementia
higher cumulative use is associated with an increased risk of dementia
most common: TCAs, antihistamines, bladder antimuscarinics
BZDs
increased risk of cognitive impairment, delirium, falls/fractures, motor vehicle crashes
BZDs and falls
doses >/ 3mg/day of diazepam increases the risk of falls/fractures by 50%
antidepressant effects
falls and anticholinergic ADEs
NSAID effects
● GI toxicity (4-5x ulcer risk)
● dose matters to relative risk
● all NSAIDs ↑ risk of AMI (&naproxen)
● concern for combo with diuretics or ACEi on renal effects
med safety summary
● ach- confusion, delirium, dementia
● BZDs- falls, delirium
● antidepressants- falls
● NSAIDs- GI, CV, renal
