inappropriate medications in the elderly (by disorder)
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Introduction
Also see Beers criteria Epidemilogy:
- geriatricians in the U.S. prescribe fewer potentially inappropriate medications than general internists[6]
Contraindications
disorder: heart failure
- drug: disopyramide (Norpace)
- concern: negative inotrope
- high Na+ content drugs
- calcium channel blocker non-dihydropyrine
- glitazones
- cilostasol
- dronedarone
- concern: fluid retention, exacerbation of heart failure
- severity rating: high
disorder: syncope
- acetylcholinesterase inhibitors
- doxazosin
- terazosin
- tricyclic antidepressants
- chlorpramazine
- thioridazine
- olanzapine
- concern: orthostatic hypotension & bradycardia
disorder: hypertension
- drug: phenylpropanolamine, pseudoephedrine, amphetamine
- concern: sympathomimetic effects
- severity rating: high
disorder: peptic ulcer
- drug: NSAIDs, aspirin
- concern: inhibition of gastroprotective prostaglandins
- severity rating: high
disorder: seizures
- bupropion (Wellbutrin)
- chlorpromazine (Thorazine)
- clozapine (Clozaril)
- maprotiline
- olanzapine
- thioridazine (Mellaril)
- thiothixene (Navane)
- tramadol
- concern: may lower seizure threshold
- severity rating: high
disorder: blood clotting disorders, anticoagulation
- drug: aspirin, NSAIDs, dipyridamole (Persantine), ticlopidine (Ticlid), clopidogrel (Plavix)
- concern: prolonged clotting time, inhibition of platelet activation, increased risk of bleeding
- severity rating: high
disorder: urinary incontinence
- estrogen
- excludes intravaginal estrogen
- concern: aggravation of urinary incontinence
disorder: overflow incontinence
- drug: anticholinergic agents, antihistamines, gastrointestinal antispasmodics, muscle relaxants, oxybutinin (Ditropan), flovaxate (Urispas), tricyclic antidepressants, decongestants, tolterodine (Detrol)
- concern: urinary retention
- severity rating: high
disorder: stress incontinence
- drug: alpha blockers (doxazosin, prazosin, terazosin), anticholinergic agents, tricyclic antidepressants (amitriptyline, imipramine, doxepine), long-acting benzodiazepines
- concern: urinary retention
- severity rating: high
disorder: BPH: lower urinary tract symptoms (LUTS)
- anticholinergic agents
- concern: urinary retention
disorder: chronic kidney disease
- NSAIDs
- triamterine
- concern: renal injury
disorder: arrhythmias
- drug: tricyclic antidepressants (amitriptyline, imipramine, doxepine)
- concern: proarrhythmic effects, QT prolongation
- severity rating: high
disorder: insomnia - docongestants
- CNS stimulants
- dextroamphetamine (Adderall)
- methylphenidate (Ritalin)
- methamphetamine (Desoxyn)
- pemoline
- caffeine
- MAO inhibitors
- theophylline
- concern: CNS stimulant
- severity rating: high
disorder: Parkinson's disease
- antiemetics
- antipsychotics
- exceptions: clozapine, quetiapine cholinesterase inhibitors
- concern: dopamine antagonists, cholinergic effects
- severity rating: high
disorder: cognitive impairment
- anticholinergic agents
- antihistamines
- antipsychotics
- antispasmodics,
- muscle relaxants
- CNS stimulants
- dextroamphetamine (Adderall),
- methylphenidate (Ritalin)
- methamphetamine (Desoxyn)
- pemoline
- zolpidem
- concern: CNS-altering effects
- severity rating: high
disorder: delirium
- tricyclic antidepressants
- anticholinergic agents
- chlorpromazine
- glucocorticoids
- antihistamines
- meperidine
- sedative/hypnotics
- thioridazine
disorder: depression
- drug: benzodiazepines (long-term use), sympatholytic agents: methyldopa (Aldomet), reserpine, guanethidine (Ismelin)
- concern: exacerbation of depression
- severity rating: high
disorder: anorexia or malnutrition
- drug: CNS stimulants: dextroamphetamine (Adderall), methylphenidate (Ritalin), methamphetamine (Desoxyn), fluoxetine (Prozac)
- concern: anorexic effect
- severity rating: high
disorder: falls (see falls in the elderly)
- anticonvulsants
- antipschotics
- benzodiazepines
- sedative/hypnotics (eszopiclone, zaleplon)
- tricyclic depressants (amitriptyline, imipramine, doxepine)
- concern: ataxia, impaired psychomotor dysfunction, syncope
- severity rating: high
disorder: hyponatremia
- drug: SSRIs: fluoxetrine (Prozac), citalopram (Celexa), fluvoxamine (Luxox), paroxetine (Paxil) sertraline (Zoloft)
- concern: SIADH
- severity rating: low
disorder: obesity drug: olanzapine concern: appetite stimulation severity rating: low
disorder: COPD
- drug: benzodiazepines, long-acting: chlordiazepoxide (Librium), diazepam (Valium), quazepam (Doral), halazepam (Paxipam), chlorazepate (Tranxene), beta-blockers: propranolol
- concern: CNS adverse effect, respiratory depression
- severity rating: high
disorder: constipation, chronic
- anticholinergic agents
- calcium channel blocker (diltiazem. verapamil)
- concern: constipation
- severity rating: low
Notes
- patients discharged from the emergency departement (ED) who received potentially inappropriate prescriptions (defined by 2015 category 1 Beers criteria) had l lower odds of revisiting the ED within 30 days of index visit[3]
- psychotropic prescribing for nursing home residents with dementia: An overview of reviews[4]
More general terms
Additional terms
References
- ↑ Fick DM, Cooper JW, Wade WE, Waller JL, Maclean JR, Beers MH. Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Arch Intern Med 2003, 163:2716 PMID: https://www.ncbi.nlm.nih.gov/pubmed/14662625
- ↑ Paauw DA 11 Drugs You Should Seriously Consider Deprescribing: 2018 Update Medscape Oncology. November 5, 2018. https://www.medscape.com/slideshow/deprescribing-6009041
- ↑ 3.0 3.1 Hammouda N, Vargas-Torres C, Doucette J, Hwang U Geriatric emergency department revisits after discharge with potentially inappropriate medications: A retrospective cohort study. Am J Emerg Med. 2021. Feb 4 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33621716 https://www.ajemjournal.com/article/S0735-6757(21)00109-1/fulltext
- ↑ 4.0 4.1 Asimopoulos M Preventing Inappropriate Use of Psychotropic Medications for NH Residents With Dementia. Annals of Long-Term-Care. 2021, June 7 https://www.managedhealthcareconnect.com/annals-long-term-care/preventing-inappropriate-use-psychotropic-medications-nh-residents-dementia
Wiggin DA, Timmons S, Rukundo A, Walsh KA. Improving the appropriateness of psychotropic prescribing for nursing home residents with dementia: An overview of reviews. Aging Ment Health. 2021;1-8 [published online ahead of print May 13, 2021]. PMID: https://www.ncbi.nlm.nih.gov/pubmed/33982608 - ↑ Talebraza S et al Geriatrics Evaluation & Management Tools American Geriatrics Society. 2021 https://geriatricscareonline.org/ProductAbstract/geriatrics-evaluation-management-tools/B007/
- ↑ 6.0 6.1 Vandergrift JL et al Geriatricians, general internists, and potentially inappropriate medications for a national sample of older adults. J Am Geriatr Soc. 2023. June https://agsjournals.onlinelibrary.wiley.com/doi/abs/10.1111/jgs.18489 PMID: https://www.ncbi.nlm.nih.gov/pubmed/37350649