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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)==
| + | #REDIRECT [[CDS]] |
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| − | '''''[[:TEST_NEW_INTRO|Also See Potentially Inappropriate Medications for Older Adults: 65 and Older Based on Updated Beers Criteria]]'''''
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| − | ----
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| − | '''''Back to'''''
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| − | [[:CDS|CDS]]
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| − | [[:CDS#Medication-Based_Safety_Rules|Medication-Based Safety Rules]]
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| − | ----
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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.
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| − | The following rule is derived for the medications below:
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| − | '''Assumptions and conditions'''
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| − | -- Based on 2000 Updated and revised Beers Criteria
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| − | -- Drugs or Drug-Classes utilized by the rule are the "Generic" names
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| − | -- Some Drugs are no longer in use
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| − | -- All Drugs below are marked with HIGH Concern
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| − | -- The patient has no other conditions beside the one intended to be treated with the drugs below
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| − | '''The Rule'''
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| − | Event Prescribe new drug OR Add new drug OR Change current Drug
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| − | '''Conditions'''
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| − | If the patient is male or female and is 65 years or older
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| − | And
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| − | If the patient has no other conditions
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| − | And
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| − | If the drug being prescribed is from the list below
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| − | And
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| − | If patient has no allergy to this drug
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| − | And
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| − | If patient have no other drugs that are contradicting to this drug
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| − | And
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| − | If the drug is dose Independent
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| − | And
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| − | If the drug is dose dependent and the dose intended is matching the dose listed in the table
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| − | Then
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| − | The Drug has a marked with HIGH Concern and the decision should be re-evaluated.----
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| − | =='''Drugs By Generic Name'''==
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| − | ===Amiodarone===
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| − | '''Drug Name (Generic)''' : Amiodarone
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| − | '''Drug Name (Brand Name)''' : Cordarone
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| − | '''Dose Dependent''' : No
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| − | '''Doses, Exceptions & Other''' : NA
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| − | '''Concerns and Rules''' : Associated with QT interval problems and risk of provoking torsades depointes.
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| − | Lack of efficacy in older adults.
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| − | ===Amitriptyline===
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| − | '''Drug Name (Generic)''' : Amitriptyline
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| − | '''Drug Name (Brand Name)''' : Elavil
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| − | '''Dose Dependent''' : No
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| − | '''Doses, Exceptions & Other''' : NA
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| − | '''Concerns and Rules''' : Because of its strong anticholinergic and sedation properties, amitriptyline is
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| − | rarely the antidepressant of choice for elderly patients.
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| − | ===Chlordiazepoxide-amitriptyline===
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| − | '''Drug Name (Generic)''' : Chlordiazepoxide-amitriptyline
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| − | '''Drug Name (Brand Name)''' : Limbitrol
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| − | '''Dose Dependent''' : No
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| − | '''Doses, Exceptions & Other''' : NA
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| − | '''Concerns and Rules''' : Because of its strong anticholinergic and sedation properties, amitriptyline is
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| − | rarely the antidepressant of choice for elderly patients.
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| − | ===Chlorpropamide===
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| − | '''Drug Name (Generic)''' : Chlorpropamide
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| − | '''Drug Name (Brand Name)''' : Limbitrol
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| − | '''Dose Dependent''' : No
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| − | '''Doses, Exceptions & Other''' : NA
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| − | '''Concerns and Rules''' : It has a prolonged half-life in elderly patients and could cause prolonged
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| − | hypoglycemia. Additionally, it is the only oral hypoglycemic agent that causes (SIADH:syndrome of inappropriate
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| − | antidiuretic hormone secretionl).
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| − | ----
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| − | =='''Drugs By Drug-Class'''==
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| − | ===Amphetamines and Amphetamines agents===
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| − | '''Drug Class''' : Amphetamines and Amphetamines agents
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| − | '''Dose Dependent''' : No
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| − | '''Doses, Exceptions & Other''' : Excluding Methylphenidate hydrochloride and Anorexics
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| − | '''Concerns and Rules''' : These drugs have potential for causing dependence, hypertension, angina, and
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| − | myocardial infarction. And (CNS:central nervous system) stimulant adverse effects.
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| − | ===Anorexic agents===
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| − | '''Drug Class''' : Anorexic agents
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| − | '''Dose Dependent''' : No
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| − | '''Doses, Exceptions & Other''' : NA
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| − | '''Concerns and Rules''' : These drugs have potential for causing dependence, hypertension, angina, and
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| − | myocardial infarction.
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| − | ===Anticholinergics and antihistamines===
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| − | '''Drug Class''' : Anticholinergics and antihistamines
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| − | '''Dose Dependent''' : No
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| − | '''Doses, Exceptions & Other''' : NA
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| − | '''Concerns and Rules''' : All nonprescription and many prescription antihistamines may have potent
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| − | anticholinergic properties. Nonanticholinergic antihistamines are preferred in elderly patients when treating
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| − | allergic reactions.
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| − | '''List of Drugs in this Class are'''
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| − | ''"Drug Generic Name:Drug Brand Name"''
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| − | '''Hydroxyzine''':Atarax
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| − | '''Diphenhydramine''':Benadryl
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| − | '''Chlorpheniramine''':Chlor-Trimeton
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| − | '''Cyproheptadine''':Periactin
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| − | '''Promethazine''':Phenergan
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| − | '''Dexchlorpheniramine''':Polaramine
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| − | '''Tripelennamine''':Tripelennamine
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| − | '''Hydroxyzine''':Vistaril
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| − | ===Barbiturates===
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| − | '''Drug Class''' : Barbiturates
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| − | '''Dose Dependent''' : No
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| − | '''Doses, Exceptions & Other''' : All type except phenobarbital Except when used to control seizures.
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| − | '''Concerns and Rules''' : Are highly addictive and cause more adverse effects than most sedative or
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| − | hypnotic drugs in elderly patients.
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| − | ===Benzodiazepines===
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| − | '''Drug Class''' : Benzodiazepines
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| − | '''Dose Dependent''' : Yes
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| − | '''Doses, Exceptions & Other''' : Doses of short-acting
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| − | '''Concerns and Rules''' : Because of increased sensitivity to benzoadiazepines in elderly patients,
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| − | smaller doses may be effective as well as safer. Total daily doses should rarely exceed the suggested maximums.
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| − | '''List of Drugs in this Class are'''
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| − | ''"Drug Generic Name:Drug Brand Name"''
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| − | '''Lorazepam''':Ativan For doses greater than 3 mg
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| − | '''Triazolam''':Halcion For doses greater than 0.25 mg
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| − | '''Temazepam''':Restoril For doses greater than 15 mg
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| − | '''Oxazepam''':Serax For doses greater than 60 mg
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| − | '''Llprazolam''':Xanax For doses greater than 2 mg
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| − | '''''Back to'''''
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| − | [[:CDS|CDS]] | + | |
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| − | [[:CDS#Medication-Based_Safety_Rules|Medication-Based Safety Rules]]
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| − | ==References==
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| − | [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]]
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| − | [[Category:CDS]]
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| − | [[Category:Medication-Based Safety Rules]]
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| − | =='''Drugs By Generic Name - Table Format'''==
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| − | <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>
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| − | <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.
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| − | <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.
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| − | <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.
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| − | <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).
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| − | <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.
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| − | <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.
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| − | <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.
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| − | <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.
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| − | <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.
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| − | <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.
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| − | <tr><td align=left>Guanadrel <tr><td align=left>Hylorel <tr><td align=left>NA <tr><td align=left>May cause orthostatic hypotension.
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| − | <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.
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| − | <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.
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| − | <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.
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| − | <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.
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| − | <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.
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| − | <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.
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| − | <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
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| − | <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
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| − | <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.
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| − | <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.
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| − | <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.
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| − | <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
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| − | <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
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| − | <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
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| − | <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.
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| − | <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.
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| − | <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.
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| − | <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.
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| − | <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.
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| − | <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.
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| − | <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.
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| − | <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.
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| − | <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.
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