STOPPFall items Flashcards
When should we consider withdrawing BZDs?
Is stepwise withdrawal needed?
- If daytime sedation, cognitive or psychomotor impairments
- If prescribed for sleep and anxiety disorder
Stepwise withdrawal needed
What should we monitor after deprescribing BZDs?
Anxiety, insomnia, agitation
(consider also monitoring delirium, seizures, confusion)
When should we consider withdrawing antipsychotics?
Is stepwise withdrawal needed?
- If EPSE or cardiac SEs, sedation, signs of sedation, dizziness, or blurred vision
- If given for BPSD or sleep disorder, maybe even if bipolar disorder
Yes stepwise withdrawal needed
What to monitor for after deprescribing antipsychotics?
Monitor for recurrence of SSx of psychosis, aggression, agitation, delusion, hallucinations
(consider monitoring insomnia)
When should we consider withdrawing opioids?
Is stepwise withdrawal needed?
- If slow reactions, impaired balance or sedation
- If given for chronic/ maybe acute pain
Yes stepwise withdrawal needed
What to monitor after deprescribing opioids?
Monitor for recurrence of pain
(consider monitoring MSK SSx, restlessness, GI SSx, anxiety, insomnia, diaphoresis, anger, chills)
When should we consider withdrawing antidepressants?
Is stepwise withdrawal needed?
- If hyponatremia, orthostatic hypotension, dizziness, sedation, or tachycardia/ arrhythmia
- If given for depression/ sleep disorder/ neuropathic pain/ anxiety disorder but SSx free for a period of time
Yes stepwise withdrawal needed
What to monitor when deprescribing antidepressants?
Monitor for recurrence of depression, anxiety, irritability, insomnia
(consider monitoring headache, malaise, GI SSx)
When should we consider withdrawing antiepileptics?
Is stepwise withdrawal needed?
- If ataxia, somnolence, impaired balance (or in case of dizziness)
- If given for anxiety disorder or neuropathic pain Yes stepwise
Consider stepwise withdrawal
What to monitor when deprescribing antiepileptics?
Monitor for recurrence of seizures
(consider monitoring anxiety, restlessness, insomnia, headache)
When should we consider withdrawing diuretics?
Is stepwise withdrawal needed?
- If orthostatic hypotension, hypotension, electrolyte disturbance and if UI
Consider stepwise withdrawal
What to monitor when deprescribing diuretics?
Monitor heart failure, hypertension, signs of fluid retention
When should we consider withdrawing alpha blockers as antihypertensives?
Is stepwise withdrawal needed?
If hypotension, OH, or dizziness
Consider stepwise withdrawal
What to monitor when deprescribing alpha blockers for hypertension?
Monitor hypertension
(consider monitoring palpitations, headache)
When should we consider withdrawing alpha blockers for BPH?
Is stepwise withdrawal needed?
- If hypotension, OH or dizziness
No need stepwise withdrawal
What to monitor when deprescribing alpha blockers for BPH?
Monitor for return of SSx
When should we consider withdrawing sedative antihistamines?
Is stepwise withdrawal needed?
- If confusion, drowsiness, dizziness, or blurred vision
Consider stepwise withdrawal
When should we consider withdrawing vasodilators used in cardiac diseases (eg nitroglycerin)?
Is stepwise withdrawal needed?
- If hypotension, OH or dizziness
Consider stepwise withdrawal
When should we consider withdrawing overactive bladder and incontinence medications?
Is stepwise withdrawal needed?
- If dizziness, confusion, blurred vision, drowsiness or increased QT-interval
Consider stepwise withdrawal
(+ monitor for return of SSx)
