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Medications that may be inappropriate for geriatrics

Medications that may be inappropriate for geriatrics

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Medications that may be inappropriate for geriatrics
Medications that may be inappropriate for geriatrics

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Published by: run.rebel.run on Dec 27, 2009
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Medications that May BeInappropriate for Geriatric Patients
 Anticholinergic antidepressants:• amitriptyline (Elavil)• doxepin (Sinequan)Strong anticholinergic and sedation propertiesRarely the antidepressant of choice for the geriatricpopulationuoxetine (Prozac) Long half-life with greater risk for CNS stimulation
 Antidiabetic Agents
chlorpropamide (Diabinese)Prolonged half-life in geriatric patients with risk forprolonged hypoglycemia Risk for SIADH
 Anticholinergic antihistamines:chlorpheniramine (Chlor-Trimeton)• cyproheptadine (Periactin)• dexchlorpheniramine (Polaramine)• diphenhydrAMINE (Benadryl)• hydrOXYzine (Vistaril, Atarax)• promethazine (Phenergan)• tripelennamine (PBZ)• Potent anticholinergicsMay cause confusion and excessive sedationShould not be used as a hypnoticUse nonanticholinergic antihistamines in the geriatricpopulation
nitrofurantoin (Macrodantin)Not effective with renal impairment 
mesoridazine (Serentil)thioridazine (Mellaril)Higher risk CNS and anticholinergic adverse product effectsRisk for QT interval prolongation and torsade de pointes
Barbiturates used for sedative/hypnotic(exception: phenobarbital for seizurecontrol)• Potential for dependenceGreater risk for adverse product effects than alternativetherapies
Benzodiazepines (long acting)
chlordiazepoxide (Librium)diazepam (Valium)flurazepam (Dalmane)Prolonged half-life in geriatric patients• Prolonged sedation effects• Increased risk for falls
Benzodiazepines (short acting [donot exceed dose in brackets])
alprazolam (Xanax) [2 mg]lorazepam (Ativan) [3 mg]temazepam (Restoril) [15 mg]Higher doses do not usually provide additional benefit Higher doses associated with increased risk of adverseproduct effectsCopyright © 2010 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
meprobamate (Miltown) May cause dependence• Excessive sedation
Cardiovascular Agents
amiodarone (Cordarone)Associated with QT interval prolongation and risk fortorsade de pointesLack of efficacy in geriatric patientsdisopyramide (Norpace, Norpace CR) Potent negative inotrope with risk for heart failure• Anticholinergicguanadrel (Hylorel)guanethidine (Ismelin)• May cause orthostatic hypotension• Safer alternatives exist methyldopa (Aldomet) Risk for bradycardiIncreased risk for depression in geriatric patientsnifedipine, short acting (Procardia, Adalat)Risk for hypotension and constipationticlopidine (Ticlid) No more effective than aspirin as antiplatele• Safer alternatives available
Gastrointestinal (GI) Drugs
GI antispasmodic agents:• dicyclomine (Bentyl)• hyoscyamine (Levsin, Levsinex)• propantheline (Pro-Banthine)• belladonna alkaloids (Donnatal)• clidinium-chlordiazepoxide (Librax)• Highly anticholinergic• Of uncertain benefit trimethobenzamide (Tigan) Extrapyramidal effects (EPS)Among the least effective antiemetics
Hormonal Agents
desiccated thyroid• Risk cardiac adverse effectsmethyltestosterone (Android, Virilon,Testrad)Potential for prostatic enlargement • Potential for cardiac problems
Stimulant laxatives (long term):• bisacodyl (Dulcolax)• cascara sagrada (Neoloid)Risk for increased bowel dysfunction considered appro-priate in the presence of opiate therapy mineral oil Risk for aspiration pneumoniCopyright © 2010 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

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