List of some PIM use independent of patient conditions and diagnosis (drugs with ADE severity rating of HIGH only)
From Clinfowiki
Revision as of 01:30, 20 February 2007 by Adamwright (Talk | contribs)
Potentially Inappropriate Medications for Older Adults: 65 and Older - Independent of Diagnoses or Conditions - Based on 2000 Upated Beers Criteria (drugs with ADE severity rating of HIGH only)
Back to
The list of drugs and drug-classes below have Concerns that Marked with HIGH in regard to prescribe to Older Adults: 65 and Older Based on 2000 Updated and revised Beers Criteria Independent of Diagnoses or Conditions.
The following rule is derived for the medications below:
Assumptions and conditions
-- Based on 2000 Updated and revised Beers Criteria -- Drugs or Drug-Classes utilized by the rule are the "Generic" names -- Some Drugs are no longer in use -- All Drugs below are marked with HIGH Concern -- The decision is independent of the patient current diagnoses or conditions.
The Rule
Rule Title: Inappropriate Medications for Older Adults: 65 and Older
Evoking Event: Prescribe new drug OR Add new drug OR Change current Drug
Conditions
If the patient is 65 years or older
And
If the drug being prescribed is from the list below
And
If the drug is dose Independent)
OR (If the drug is dose dependent AND the dose intended is greater than or equal to the dose listed in
the table))
Then
1 - The decision to prescribe the drug should be re-evaluated as the order has a HIGH potential for being used
inappropriately in older adults.
2 - Use The ALTERNATIVE Drug or The ALTERNATIVE Dose
Back to
References
Aiman Alrawabdeh
| Drugs By Generic Name |
|---|
| Drug Name (Generic) | Drug Name (Brand Name) | Doses, Exceptions & Other | Concerns and Rules | Alternative Drug | Alternative Dose |
|---|---|---|---|---|---|
| Amiodarone | Cordarone | NA | Associated with QT interval problems and risk of provoking torsades depointes. Lack of efficacy in older adults. | TBD | TBD |
| Amitriptyline | Elavil | NA | Because of its strong anticholinergic and sedation properties, amitriptyline is rarely the antidepressant of choice for elderly patients. | TBD | TBD |
| Chlordiazepoxide-amitriptyline | Limbitrol | NA | Because of its strong anticholinergic and sedation properties, amitriptyline is rarely the antidepressant of choice for elderly patients. | TBD | TBD |
| Chlorpropamide | Diabinese | NA | It has a prolonged half-life in elderly patients and could cause prolonged hypoglycemia. Additionally, it is the only oral hypoglycemic agent that causes (SIADH:syndrome of inappropriate antidiuretic hormone secretionl). | TBD | TBD |
| Desiccated thyroid | Desiccated thyroid | NA | Concerns about cardiac effects. Safer alternatives available. | TBD | TBD |
| Disopyramide | Norpace | NA | Of all antiarrhythmic drugs, this is the most potent negative inotrope and therefore may induce heart failure in elderly patients. It is also strongly anticholinergic. Other antiarrhythmic drugs should be used. | TBD | TBD |
| Disopyramide CR | Norpace CR | NA | Of all antiarrhythmic drugs, this is the most potent negative inotrope and therefore may induce heart failure in elderly patients. It is also strongly anticholinergic. Other antiarrhythmic drugs should be used. | TBD | TBD |
| Doxepin | Sinequan | NA | Because of its strong anticholinergic and sedating properties, doxepin is rarely the antidepressant of choice for elderly patients. | TBD | TBD |
| Fluoxetine | Prozac | Daily Dose | Long half-life of drug and risk of producing excessive (CNS:central nervous system) stimulation, sleep disturbances, and increasing agitation. Safer alternatives exist. | TBD | TBD |
| Flurazepam | Dalmane | NA | This benzodiazepine hypnotic has an extremely long half-life in elderly patients (often days), producing prolonged sedation and increasing the incidence of falls and fracture. Medium- or short-acting benzodiazepines are preferable. | TBD | TBD |
| Guanadrel | Hylorel | NA | May cause orthostatic hypotension. | TBD | TBD |
| Guanethidine | Ismelin | NA | May cause orthostatic hypotension. Safer alternatives exist. | TBD | TBD |
| Indomethacin | Indocin | NA | Of all available nonsteroidal anti-inflammatory drugs, this drug produces the most (CNS:central nervous system) adverse effects. | TBD | TBD |
| Indomethacin | Indocin SR | NA | Of all available nonsteroidal anti-inflammatory drugs, this drug produces the most (CNS:central nervous system) adverse effects. | TBD | TBD |
| Ketorolac | Toradol | NA | Immediate and long-term use should be avoided in older persons, since a significant number have asymptomatic (GI: gastrointestinal) pathologic conditions. | TBD | TBD |
| Mellaril | Mellaril | NA | Greater potential for (CNS:central nervous system) and extrapyramidal adverse effects. | TBD | TBD |
| Meperidine | Demerol | NA | Not an effective oral analgesic in doses commonly used. May cause confusion and has many disadvantages to other narcotic drugs. | TBD | TBD |
| Meprobamate | Equanil | NA | This is a highly addictive and sedating anxiolytic. Those using meprobamate for prolonged periods may become addicted and may need to be withdrawn slowly | TBD | TBD |
| Meprobamate | Miltown | NA | This is a highly addictive and sedating anxiolytic. Those using meprobamate for prolonged periods may become addicted and may need to be withdrawn slowly | TBD | TBD |
| Mesoridazine | Serentil | NA | (CNS:central nervous system) and extrapyramidal adverse effects. | TBD | TBD |
| Methyldopa | Aldomet | NA | May cause bradycardia and exacerbate depression in elderly patients. | TBD | TBD |
| Methyldopa-hydrochlorothiazide | Aldoril | NA | May cause bradycardia and exacerbate depression in elderly patients. | TBD | TBD |
| Methyltestosterone | Android | NA | Potential for prostatic hypertrophy and cardiac problems | TBD | TBD |
| Methyltestosterone | Testrad | NA | Potential for prostatic hypertrophy and cardiac problems | TBD | TBD |
| Methyltestosterone | Virilon | NA | Potential for prostatic hypertrophy and cardiac problems | TBD | TBD |
| Mineral oil | Mineral oil | NA | Potential for aspiration and adverse effects. Safer alternatives available. | TBD | TBD |
| Nifedipine | Adalat | Short acting doses | Potential for hypotension and constipation. | TBD | TBD |
| Nifedipine | Procardia | Short acting doses | Potential for hypotension and constipation. | TBD | TBD |
| Nitrofurantoin | Macrodantin | NA | Potential for renal impairment. Safer alternatives available. | TBD | TBD |
| Orphenadrine | Norflex | NA | Causes more sedation and anticholinergic adverse effects than safer alternatives. | TBD | TBD |
| Pentazocine | Talwin | NA | Narcotic analgesic that causes more (CNS:central nervous system) adverse effects, including confusion and hallucinations, more commonly than other narcotic drugs. Additionally, it is a mixed agonist and antagonist. | TBD | TBD |
| Perphenazine-amitriptyline | Triavil | NA | Because of its strong anticholinergic and sedation properties, amitriptyline is rarely the antidepressant of choice for elderly patients. | TBD | TBD |
| Ticlopidine | Ticlid | NA | Has been shown to be no better than aspirin in preventing clotting and may be considerably more toxic. Safer, more effective alternatives exist. | TBD | TBD |
| Trimethobenzamide | Tigan | NA | One of the least effective antiemetic drugs, yet it can cause extrapyramidal adverse effects. | TBD | TBD |
| Drugs By Drug Classes |
|---|
| Drug Class | Done Dependent | Doses, Exceptions & Other | Concerns and Rules | Alternative Drug | Alternative Dose |
|---|---|---|---|---|---|
| Amphetamines and Amphetamines agents | NO | Excluding:Methylphenidate hydrochloride and Anorexics | These drugs have potential for causing dependence, hypertension, angina, and myocardial infarction. CNS:central nervous system) stimulant adverse effects. | TBD | TBD |
| Anorexic agents | NO | NA | These drugs have potential for causing dependence, hypertension, angina, and myocardial infarction. | TBD | TBD |
| Anticholinergics and antihistamine Hydroxyzine:Atarax Diphenhydramine:Benadryl Chlorpheniramine:Chlor-Trimeton Cyproheptadine:Periactin Promethazine:Phenergan Dexchlorpheniramine:Polaramine Tripelennamine:Tripelennamine Hydroxyzine:Vistaril | NO | NA | All nonprescription and many prescription antihistamines may have potent anticholinergic properties. Nonanticholinergic antihistamines are preferred in elderly patients when treating allergic reactions. | TBD | TBD |
| Barbiturates | NO | All type except phenobarbital Except when used to control seizures | Are highly addictive and cause more adverse effects than most sedative or hypnotic drugs in elderly patients. | TBD | TBD |
| Benzodiazepines Lorazepam:Ativan Triazolam:Halcion Temazepam:Restoril Oxazepam:Serax Llprazolam:Xanax | Yes | Doses of short-acting For doses greater than 3 mg For doses greater than 0.25 mg For doses greater than 15 mg For doses greater than 60 mg For doses greater than 2 mg | Because of increased sensitivity to benzoadiazepines in elderly patients, smaller doses may be effective as well as safer. Total daily doses should rarely exceed the suggested maximums. | TBD | TBD |
| Gastrointestinal antispasmodic drugs Dicyclomine:Bentyl Hyoscyamine:Levsin Hyoscyamine:Levsinex Clidinium-chlordiazepoxide:Librax Propantheline:Pro-Banthine Belladonna alkaloids:Donnatal | No | NA | (GI: gastrointestinal) antispasmodic drugs are highly anticholinergic and have uncertain effectiveness. These drugs should be avoided (especially for long-term use). | TBD | TBD |
| Muscle relaxants and antispasmodics Oxybutynin XL:Ditropan XL Oxybutynin:Ditropan Cyclobenzaprine:Flexeril Chlorzoxazone:Paraflex Methocarbamol:Robaxin Metaxalone:Skelaxin Carisoprodol:Soma | No | NA | Most muscle relaxants and antispasmodic drugs are poorly tolerated by elderly patients, since these cause anticholinergic adverse effects, sedation, and weakness. Additionally, their effectiveness at doses tolerated by elderly patients is questionable. | TBD | TBD |
| Non–COX-selective NSAIDs (Non-Cyclooxygenase-Selective Nonsteroidal Anti-Inflammatory Drugs) Naproxen:Aleve Naproxen:Avaprox Oxaprozin:Daypro Naproxen :Naprosyn | No | Long-term use of full-dosage, longer half-life | Have the potential to produce (GI: gastrointestinal) bleeding, renal failure, high blood pressure, and heart failure. | TBD | TBD |
| Stimulant Laxatives Cascara sagrada:Cascara sagrada Bisacodyl:Dulcolax Neoloid:Neoloid | No | Long-term use Except in the presence of opiate analgesic use | May exacerbate bowel dysfunction. | TBD | TBD |
