Safe Medication Use for Older Adults

Question 1

Clinical Geriatrics

Answer 1

Maintenance of independence & prevention of disability
Multiple comorbidities
Any symptom in an elderly patient should be considered a drug side effect until proven otherwise.

Question 2

Polypharmacy

Answer 2

Use of multiple dugs by a single patient for one or more conditions
May include “prescribing cascades”

Question 3

Prescribing cascade

Answer 3

Using a medication to treat a side effect of another medication

Question 4

Potentially inappropriate medications

Answer 4

Medications in with the most potential risks outweigh the potential benefits for most older adults
Use of these medications have been shown to be an independent risk factor for healthcare utilization and increased costs to paitents

Question 5

Medication Adherence

Answer 5

Nonadherence can cause hospitalizations
“intelligent noncompliance”

Question 6

Tools to identify PIMS

Answer 6

AGS Beers Criteria
START/STOPP Criteria
Medication Appropriateness Index
Anticholinergic Risk Scale

Question 7

STOPP

Answer 7

Screening Tool of Older Persons’ potentially inappropriate Prescriptions
Indicates drug-drug, drug-disease, duration of treatment, dose rules

Question 8

START

Answer 8

Screening Tool to Alert doctors to the Right Treatment
Indicates omitted drugs

Question 9

Anticholinergic side effects

Answer 9

Vision: Impaired ADL, falls and accidents
Oral cavity: Decline in nutritional status, increased risk of infection, worsened communication
GI tract: Decline in nutritional status, worsening of disease, anxiety, pain
CV system: Worsening of disease, anxiety
Urinary tract: Incontinence, infection, loss of independence
CNS: cognitive dysfunction, impaired ADL

Question 10

Anticholinergic medications

Answer 10

Muscle relaxants: Cyclobenzaprine, methocarbamol, carisoprodol, oxybutynin
TCAs: Amitriptyline, nortriptyline, doxepin
Antispasmodics: Dicyclomine, hyoscyamine, propantheline
Antihistamines: Diphenhydramine, chlorpheniramine, cyproheptadine, hydroxyzine, promethazine

Question 11

Poor outcomes for Anti-Ach drugs

Answer 11

Limitations in physical and cognitive function
Worse memory and executive function
ACHE-i and bladder anticholinergics and had higher baseline cognitive function experienced a greater rate of functional decline than those on ACHE-i alone
Increased risk of dementia

Question 12

Benzodiazepines

Answer 12

Increased risk of cognitive impairment, delirium, falls/fractures, MVAs
Increased risk of falls and hip fractures

Question 13

Antidepressants

Answer 13

Falls, Anticholinergic ADR

Question 14

NSAID toxicities in older adults

Answer 14

GI toxicity, CV risks, renal considerations, ulcer risk
Dose dependent

Question 15

NSAID induced injury prevention

Answer 15

Misoprostol: Lower doses, decreased diarrhea, but less effective
H2RA: Double doses effective
PPI: Standard dose effective
High risk GI patients: COX-2 alone or NSAID + PPI offer similar but potentially insufficient protection

Question 16

NSAIDs + Cardiovascular Risk

Answer 16

Increased risk of AMI
BBW: Can cause heart attacks or strokes

Question 17

NSAID Renal Effects in Older Adults

Answer 17

Reductions in renal blood flow, sodium and water retention, concerns for combinations with ACEI or diuretics