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)

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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)

Also See Potentially Inappropriate Medications for Older Adults: 65 and Older Based on Updated Beers Criteria


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CDS

Medication-Based Safety Rules


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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CDS

Medication-Based Safety Rules


References

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


Aiman Alrawabdeh 5/28/2006


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Drugs By Generic Name
Drug Name (Generic) Drug Name (Brand Name) Doses, Exceptions & Other Concerns and Rules
Amiodarone Cordarone NA Associated with QT interval problems and risk of provoking torsades depointes. Lack of efficacy in older adults.
Amitriptyline Elavil NA Because of its strong anticholinergic and sedation properties, amitriptyline is rarely the antidepressant of choice for elderly patients.
Chlordiazepoxide-amitriptyline Limbitrol NA Because of its strong anticholinergic and sedation properties, amitriptyline is rarely the antidepressant of choice for elderly patients.
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).
Desiccated thyroid Desiccated thyroid NA Concerns about cardiac effects. Safer alternatives available.
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.
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.
Doxepin Sinequan NA Because of its strong anticholinergic and sedating properties, doxepin is rarely the antidepressant of choice for elderly patients.
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.
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.
Guanadrel Hylorel NA May cause orthostatic hypotension.
Guanethidine Ismelin NA May cause orthostatic hypotension. Safer alternatives exist.
Indomethacin Indocin NA Of all available nonsteroidal anti-inflammatory drugs, this drug produces the most (CNS:central nervous system) adverse effects.
Indomethacin Indocin SR NA Of all available nonsteroidal anti-inflammatory drugs, this drug produces the most (CNS:central nervous system) adverse effects.
Ketorolac Toradol NA Immediate and long-term use should be avoided in older persons, since a significant number have asymptomatic (GI: gastrointestinal) pathologic conditions.
Mellaril Mellaril NA Greater potential for (CNS:central nervous system) and extrapyramidal adverse effects.
Meperidine Demerol NA Not an effective oral analgesic in doses commonly used. May cause confusion and has many disadvantages to other narcotic drugs.
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
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
Mesoridazine Serentil NA (CNS:central nervous system) and extrapyramidal adverse effects.
Methyldopa Aldomet NA May cause bradycardia and exacerbate depression in elderly patients.
Methyldopa-hydrochlorothiazide Aldoril NA May cause bradycardia and exacerbate depression in elderly patients.
Methyltestosterone Android NA Potential for prostatic hypertrophy and cardiac problems
Methyltestosterone Testrad NA Potential for prostatic hypertrophy and cardiac problems
Methyltestosterone Virilon NA Potential for prostatic hypertrophy and cardiac problems
Mineral oil Mineral oil NA Potential for aspiration and adverse effects. Safer alternatives available.
Nifedipine Adalat Short acting doses Potential for hypotension and constipation.
Nifedipine Procardia Short acting doses Potential for hypotension and constipation.
Nitrofurantoin Macrodantin NA Potential for renal impairment. Safer alternatives available.
Orphenadrine Norflex NA Causes more sedation and anticholinergic adverse effects than safer alternatives.
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.
Perphenazine-amitriptyline Triavil NA Because of its strong anticholinergic and sedation properties, amitriptyline is rarely the antidepressant of choice for elderly patients.
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.
Trimethobenzamide Tigan NA One of the least effective antiemetic drugs, yet it can cause extrapyramidal adverse effects.
====
Drugs By Drug Classes
Drug Class

Drug Name:Brand Name

Done DependentDoses, Exceptions & Other Concerns and Rules
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.


Anorexic agents NO NA These drugs have potential for causing dependence, hypertension, angina, and myocardial infarction.
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.


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.


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.


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).


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.


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.


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.