View source for 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)

==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)==

'''''[[:TEST_NEW_INTRO|Also See Potentially Inappropriate Medications for Older Adults: 65 and Older Based on Updated Beers Criteria]]'''''
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'''''Back to'''''

[[:CDS|CDS]]

[[:CDS#Medication-Based_Safety_Rules|Medication-Based Safety Rules]]
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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 patient has no other conditions beside the one intended to be treated with the drugs below

'''The Rule'''

 Event Prescribe new drug OR Add new drug OR Change current Drug
 '''Conditions'''
 If the patient is male or female and is 65 years or older
 And
 If the patient has no other conditions 
 And
 If the drug being prescribed is from the list below
 And
 If patient has no allergy to this drug
 And
 If patient have no other drugs that are contradicting to this drug
 And
 If the drug is dose Independent
 And
 If the drug is dose dependent and the dose intended is matching the dose listed in the table 
 Then
 The Drug has a marked with HIGH Concern and the decision should be re-evaluated.----

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=='''Drugs By Generic Name'''==

===Amiodarone===
 '''Drug Name (Generic)'''   	   : Amiodarone
 '''Drug Name (Brand Name)'''	   : Cordarone
 '''Dose Dependent'''	       	   : No
 '''Doses, Exceptions & Other'''  : NA
 '''Concerns and Rules''' 	   : Associated with QT interval problems and risk of provoking torsades depointes. 
 Lack of efficacy in older adults.
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===Amitriptyline===
 '''Drug Name (Generic)'''   	   : Amitriptyline
 '''Drug Name (Brand Name)'''	   : Elavil
 '''Dose Dependent'''	       	   : No
 '''Doses, Exceptions & Other'''  : NA
 '''Concerns and Rules''' 	   : Because of its strong anticholinergic and sedation properties, amitriptyline is 
 rarely the antidepressant of choice for elderly patients.
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===Chlordiazepoxide-amitriptyline===
 '''Drug Name (Generic)'''   	   : Chlordiazepoxide-amitriptyline
 '''Drug Name (Brand Name)'''	   : Limbitrol
 '''Dose Dependent'''	       	   : No
 '''Doses, Exceptions & Other'''  : NA
 '''Concerns and Rules''' 	   : Because of its strong anticholinergic and sedation properties, amitriptyline is 
 rarely the antidepressant of choice for elderly patients.
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===Chlorpropamide===
 '''Drug Name (Generic)'''   	   : Chlorpropamide
 '''Drug Name (Brand Name)'''	   : Limbitrol
 '''Dose Dependent'''	       	   : No
 '''Doses, Exceptions & Other'''  : NA
 '''Concerns and Rules''' 	   : 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).
----

=='''Drugs By Drug-Class'''==
===Amphetamines and Amphetamines agents===
 '''Drug Class'''   	          : Amphetamines and Amphetamines agents
 '''Dose Dependent'''	          : No
 '''Doses, Exceptions & Other''' : Excluding Methylphenidate hydrochloride and Anorexics
 '''Concerns and Rules''' 	  : These drugs have potential for causing dependence, hypertension, angina, and 
 myocardial infarction. And (CNS:central nervous system) stimulant adverse effects.
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===Anorexic agents===
 '''Drug Class'''   	          : Anorexic agents
 '''Dose Dependent'''	          : No
 '''Doses, Exceptions & Other''' : NA
 '''Concerns and Rules''' 	  : These drugs have potential for causing dependence, hypertension, angina, and 
 myocardial infarction.                           
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===Anticholinergics and antihistamines===
 '''Drug Class'''   	          : Anticholinergics and antihistamines
 '''Dose Dependent'''	          : No
 '''Doses, Exceptions & Other''' : NA
 '''Concerns and Rules''' 	  : All nonprescription and many prescription antihistamines may have potent 
 anticholinergic properties. Nonanticholinergic antihistamines are preferred in elderly patients when treating 
 allergic reactions.
 '''List of Drugs in this Class are''' 
 ''"Drug Generic Name:Drug Brand Name"''
 '''Hydroxyzine''':Atarax
 '''Diphenhydramine''':Benadryl
 '''Chlorpheniramine''':Chlor-Trimeton
 '''Cyproheptadine''':Periactin
 '''Promethazine''':Phenergan
 '''Dexchlorpheniramine''':Polaramine
 '''Tripelennamine''':Tripelennamine 
 '''Hydroxyzine''':Vistaril
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===Barbiturates===
 '''Drug Class'''   	          : Barbiturates
 '''Dose Dependent'''	          : No
 '''Doses, Exceptions & Other''' : All type except phenobarbital Except when used to control seizures.
 '''Concerns and Rules''' 	  : Are highly addictive and cause more adverse effects than most sedative or 
 hypnotic drugs in elderly patients.
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===Benzodiazepines===
 '''Drug Class'''   	          : Benzodiazepines
 '''Dose Dependent'''	          : Yes
 '''Doses, Exceptions & Other''' : Doses of short-acting
 '''Concerns and Rules''' 	  : 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.
 '''List of Drugs in this Class are''' 
 ''"Drug Generic Name:Drug Brand Name"''
 '''Lorazepam''':Ativan   For doses greater than 3 mg
 '''Triazolam''':Halcion  For doses greater than 0.25 mg
 '''Temazepam''':Restoril For doses greater than 15 mg
 '''Oxazepam''':Serax     For doses greater than 60 mg
 '''Llprazolam''':Xanax   For doses greater than 2 mg
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'''''Back to'''''

[[:CDS|CDS]]

[[:CDS#Medication-Based_Safety_Rules|Medication-Based Safety Rules]]

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==References==
[http://archinte.ama-assn.org/cgi/content/full/163/22/2716 Donna M. Fick, PhD, RN, et al. Updating the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults:Results of a US Consensus Panel of Experts. Archives of Internal Medicine. 2003;163:2716-2724]

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'''Aiman Alrawabdeh 5/28/2006'''

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[[Category:OHSU-SP-06]]
[[Category:CDS]]
[[Category:Medication-Based Safety Rules]]

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=='''Drugs By Generic Name - Table Format'''==
<th align=left>	 Drug Name (Generic)	</th><th align=left>	Drug Name (Brand Name)	</th><th align=left>	Doses, Exceptions & Other	</th><th align=left>	Concerns and Rules	</th>
<tr><td align=left>Amiodarone	</td><td align=left>	Cordarone	</td><td align=left>	NA	</td><td align=left>	Associated with QT interval problems and risk of provoking torsades depointes. Lack of efficacy in older adults.	
<tr><td align=left>Amitriptyline	<tr><td align=left>Elavil	<tr><td align=left>NA	<tr><td align=left>Because of its strong anticholinergic and sedation properties, amitriptyline is rarely the antidepressant of choice for elderly patients.	
<tr><td align=left>Chlordiazepoxide-amitriptyline	<tr><td align=left>Limbitrol	<tr><td align=left>NA	<tr><td align=left>Because of its strong anticholinergic and sedation properties, amitriptyline is rarely the antidepressant of choice for elderly patients.	
<tr><td align=left>Chlorpropamide	<tr><td align=left>Diabinese	<tr><td align=left>NA	<tr><td align=left>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).	
<tr><td align=left>Desiccated thyroid	<tr><td align=left>Desiccated thyroid	<tr><td align=left>NA	<tr><td align=left>Concerns about cardiac effects. Safer alternatives available.	
<tr><td align=left>Disopyramide	<tr><td align=left>Norpace	<tr><td align=left>NA	<tr><td align=left>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.	
<tr><td align=left>Disopyramide CR	<tr><td align=left>Norpace CR	<tr><td align=left>NA	<tr><td align=left>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.	
<tr><td align=left>Doxepin	<tr><td align=left>Sinequan	<tr><td align=left>NA	<tr><td align=left>Because of its strong anticholinergic and sedating properties, doxepin is rarely the antidepressant of choice for elderly patients.	
<tr><td align=left>Fluoxetine	<tr><td align=left>Prozac<tr><td align=left>Daily Dose	<tr><td align=left>Long half-life of drug and risk of producing excessive (CNS:central nervous system) stimulation, sleep disturbances, and increasing agitation. Safer alternatives exist.	
<tr><td align=left>Flurazepam	<tr><td align=left>Dalmane	<tr><td align=left>NA	<tr><td align=left>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.	
<tr><td align=left>Guanadrel	<tr><td align=left>Hylorel	<tr><td align=left>NA	<tr><td align=left>May cause orthostatic hypotension.	
<tr><td align=left>Guanethidine	<tr><td align=left>Ismelin	<tr><td align=left>NA	<tr><td align=left>May cause orthostatic hypotension. Safer alternatives exist.	
<tr><td align=left>Indomethacin	<tr><td align=left>Indocin	<tr><td align=left>NA	<tr><td align=left>Of all available nonsteroidal anti-inflammatory drugs, this drug produces the most (CNS:central nervous system) adverse effects.	
<tr><td align=left>Indomethacin	<tr><td align=left>Indocin SR	<tr><td align=left>NA	<tr><td align=left>Of all available nonsteroidal anti-inflammatory drugs, this drug produces the most (CNS:central nervous system) adverse effects.	
<tr><td align=left>Ketorolac	<tr><td align=left>Toradol	<tr><td align=left>NA	<tr><td align=left>Immediate and long-term use should be avoided in older persons, since a significant number have asymptomatic (GI: gastrointestinal) pathologic conditions.	
<tr><td align=left>Mellaril	<tr><td align=left>Mellaril	<tr><td align=left>NA	<tr><td align=left>Greater potential for (CNS:central nervous system) and extrapyramidal adverse effects.
<tr><td align=left>Meperidine	<tr><td align=left>Demerol	<tr><td align=left>NA	<tr><td align=left>Not an effective oral analgesic in doses commonly used. May cause confusion and has many disadvantages to other narcotic drugs.
<tr><td align=left>Meprobamate	<tr><td align=left>Equanil	<tr><td align=left>NA	<tr><td align=left>This is a highly addictive and sedating anxiolytic. Those using meprobamate for prolonged periods may become addicted and may need to be withdrawn slowly
<tr><td align=left>Meprobamate	<tr><td align=left>Miltown	<tr><td align=left>NA	<tr><td align=left>This is a highly addictive and sedating anxiolytic. Those using meprobamate for prolonged periods may become addicted and may need to be withdrawn slowly
<tr><td align=left>Mesoridazine	<tr><td align=left>Serentil	<tr><td align=left>NA	<tr><td align=left>(CNS:central nervous system) and extrapyramidal adverse effects.
<tr><td align=left>Methyldopa	<tr><td align=left>Aldomet	<tr><td align=left>NA	<tr><td align=left>May cause bradycardia and exacerbate depression in elderly patients.
<tr><td align=left>Methyldopa-hydrochlorothiazide	<tr><td align=left>Aldoril	<tr><td align=left>NA	<tr><td align=left>May cause bradycardia and exacerbate depression in elderly patients.
<tr><td align=left>Methyltestosterone<tr><td align=left>Android	<tr><td align=left>NA	<tr><td align=left>Potential for prostatic hypertrophy and cardiac problems
<tr><td align=left>Methyltestosterone<tr><td align=left>Testrad	<tr><td align=left>NA	<tr><td align=left>Potential for prostatic hypertrophy and cardiac problems
<tr><td align=left>Methyltestosterone<tr><td align=left>Virilon	<tr><td align=left>NA	<tr><td align=left>Potential for prostatic hypertrophy and cardiac problems
<tr><td align=left>Mineral oil	<tr><td align=left>Mineral oil	<tr><td align=left>NA	<tr><td align=left>Potential for aspiration and adverse effects. Safer alternatives available.
<tr><td align=left>Nifedipine	<tr><td align=left>Adalat	<tr><td align=left>Short acting doses	<tr><td align=left>Potential for hypotension and constipation.
<tr><td align=left>Nifedipine	<tr><td align=left>Procardia	<tr><td align=left>Short acting doses	<tr><td align=left>Potential for hypotension and constipation.
<tr><td align=left>Nitrofurantoin	<tr><td align=left>Macrodantin	<tr><td align=left>NA	<tr><td align=left>Potential for renal impairment. Safer alternatives available.
<tr><td align=left>Orphenadrine	<tr><td align=left>Norflex	<tr><td align=left>NA	<tr><td align=left>Causes more sedation and anticholinergic adverse effects than safer alternatives.
<tr><td align=left>Pentazocine	<tr><td align=left>Talwin	<tr><td align=left>NA	<tr><td align=left>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.
<tr><td align=left>Perphenazine-amitriptyline	<tr><td align=left>Triavil	<tr><td align=left>NA	<tr><td align=left>Because of its strong anticholinergic and sedation properties, amitriptyline is rarely the antidepressant of choice for elderly patients.
<tr><td align=left>Ticlopidine	<tr><td align=left>Ticlid	<tr><td align=left>NA	<tr><td align=left>Has been shown to be no better than aspirin in preventing clotting and may be considerably more toxic. Safer, more effective alternatives exist.
<tr><td align=left>Trimethobenzamide	<tr><td align=left>Tigan	<tr><td align=left>NA	<tr><td align=left>One of the least effective antiemetic drugs, yet it can cause extrapyramidal adverse effects.