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inappropriate medications in the elderly (by disorder)

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 - diltiazem - verapamil - glitazones - pioglitazone - rosiglitazone - 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 - metoclopramide (Reglan) - prochlorperazine - promethazine - 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 - solifenacin - tolterodine - trospium - antihistamines - antipsychotics - scopolamine - tricyclic antidepressants (amitriptyline, imipramine, doxepin, trimipramine)) - belladonna alkaloids - 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]

Related

Beers criteria

General

geriatric disorder; disease of old age; geriatric syndrome inappropriate prescription

References

  1. 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: 14662625
  2. Paauw DA 11 Drugs You Should Seriously Consider Deprescribing: 2018 Update Medscape Oncology. November 5, 2018. https://www.medscape.com/slideshow/deprescribing-6009041
  3. 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: 33621716 https://www.ajemjournal.com/article/S0735-6757(21)00109-1/fulltext
  4. 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: 33982608
  5. Talebraza S et al Geriatrics Evaluation & Management Tools American Geriatrics Society. 2021 https://geriatricscareonline.org/ProductAbstract/geriatrics-evaluation-management-tools/B007/
  6. 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: 37350649