Difference between revisions of "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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| − | 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 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: | The following rule is derived for the medications below: | ||
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| − | '''Drugs By Generic Name''' | + | =='''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. | ||
| + | ---- | ||
| + | ===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. | ||
| + | ---- | ||
| + | ===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. | ||
| + | ---- | ||
| + | ===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''' | + | =='''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. | ||
| + | : (CNS:central nervous system) stimulant adverse effects. | ||
| + | ---- | ||
| + | ===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. | ||
| + | ---- | ||
| + | ===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 | ||
| + | ---- | ||
| + | ===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. | ||
| + | ---- | ||
| + | ===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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| − | + | ==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] | [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] | ||
Revision as of 01:01, 31 May 2006
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Potentially Inappropriate Medications for Older Adults: 65 and Older - Independent of Diagnoses or Conditions - Based on 2000 Upated Beers Criteria
Also See Upated Beers Criteria
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.----
Contents
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.
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.
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.
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.
: (CNS:central nervous system) stimulant adverse effects.
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.
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
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.
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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References
Aiman Alrawabdeh 5/28/2006
