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− | ==Potentially Inappropriate Medications for Older Adults: 65 and Older - Independent of Diagnoses or Conditions - Based on 2000 Upated Beers Criteria==
| + | #REDIRECT [[CDS]] |
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− | '''''[[:Potentially_Inappropriate_Medication_%28PIM%29_Use_in_Older_Adults:_65_and_Older_-_Independent_of_Diagnoses_or_Conditions_-_Based_on_Upated_Beers_Criteria|Also See Upated 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. 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 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 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 hypoglycemia. Additionally, it is the only oral hypoglycemic agent that causes (SIADH:syndrome of inappropriate antidiuretic hormone secretionl).
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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 myocardial infarction.
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− | : (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 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 anticholinergic properties. Nonanticholinergic antihistamines are preferred in elderly patients when treating 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 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, 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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− | ----
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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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− | ==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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