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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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06/26/2014

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Medications that May Be Inappropriate for Geriatric Patients

DRUG Antidepressants Anticholinergic antidepressants: • amitriptyline (Elavil) • doxepin (Sinequan) fluoxetine (Prozac) Antidiabetic Agents chlorpropamide (Diabinese) Antihistamines Anticholinergic antihistamines: • chlorpheniramine (Chlor-Trimeton) • cyproheptadine (Periactin) • dexchlorpheniramine (Polaramine) • diphenhydrAMINE (Benadryl) • hydrOXYzine (Vistaril, Atarax) • promethazine (Phenergan) • tripelennamine (PBZ) Antiinfective nitrofurantoin (Macrodantin) Antipsychotics mesoridazine (Serentil) thioridazine (Mellaril) Anxiolytics/Sedatives Barbiturates used for sedative/hypnotic (exception: phenobarbital for seizure control) Benzodiazepines (long acting) chlordiazepoxide (Librium) diazepam (Valium) flurazepam (Dalmane) Benzodiazepines (short acting [do not exceed dose in brackets]) alprazolam (Xanax) [2 mg] lorazepam (Ativan) [3 mg] temazepam (Restoril) [15 mg] CONCERN • Strong anticholinergic and sedation properties • Rarely the antidepressant of choice for the geriatric population • Long half-life with greater risk for CNS stimulation • Prolonged half-life in geriatric patients with risk for prolonged hypoglycemia • Risk for SIADH • • • • Potent anticholinergics May cause confusion and excessive sedation Should not be used as a hypnotic Use nonanticholinergic antihistamines in the geriatric population

• Not effective with renal impairment • Higher risk CNS and anticholinergic adverse product effects • Risk for QT interval prolongation and torsade de pointes • Potential for dependence • Greater risk for adverse product effects than alternative therapies • Prolonged half-life in geriatric patients • Prolonged sedation effects • Increased risk for falls • Higher doses do not usually provide additional benefit • Higher doses associated with increased risk of adverse product effects

Copyright © 2010 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

meprobamate (Miltown) Cardiovascular Agents amiodarone (Cordarone) disopyramide (Norpace, Norpace CR) guanadrel (Hylorel) guanethidine (Ismelin) methyldopa (Aldomet) nifedipine, short acting (Procardia, Adalat) ticlopidine (Ticlid) Gastrointestinal (GI) Drugs GI antispasmodic agents: • dicyclomine (Bentyl) • hyoscyamine (Levsin, Levsinex) • propantheline (Pro-Banthine) • belladonna alkaloids (Donnatal) • clidinium-chlordiazepoxide (Librax) trimethobenzamide (Tigan) Hormonal Agents desiccated thyroid methyltestosterone (Android, Virilon, Testrad) Laxatives Stimulant laxatives (long term): • bisacodyl (Dulcolax) • cascara sagrada (Neoloid) mineral oil

• May cause dependence • Excessive sedation • Associated with QT interval prolongation and risk for torsade de pointes • Lack of efficacy in geriatric patients • Potent negative inotrope with risk for heart failure • Anticholinergic • May cause orthostatic hypotension • Safer alternatives exist • Risk for bradycardia • Increased risk for depression in geriatric patients • Risk for hypotension and constipation • No more effective than aspirin as antiplatelet • Safer alternatives available • Highly anticholinergic • Of uncertain benefit

• Extrapyramidal effects (EPS) • Among the least effective antiemetics • Risk cardiac adverse effects • Potential for prostatic enlargement • Potential for cardiac problems • Risk for increased bowel dysfunction considered appropriate in the presence of opiate therapy

• Risk for aspiration pneumonia

Copyright © 2010 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

Muscle Relaxants and Antispasmodics carisoprodol (Soma) chlorzoxazone (Paraflex) cyclobenzaprine (Flexeril) metaxalone (Skelaxin) methocarbamol (Robaxin) orphenadrine (Norflex) oxybutynin (Ditropan) Nonsteroidal Antiinflammatory Drugs (NSAIDs) indomethacin (Indocin and Indocin SR) ketorolac (Toradol) NSAIDs, long-term use of longer half-life, non–COX-selective naproxen (Naprosyn, Anaprox, Aleve) oxaprozin (Daypro) piroxicam (Feldene) Opioid Analgesics meperidine (Demerol) pentazocine (Talwin) Stimulants amphetamines anorexic products

• Anticholinergic adverse effects • Excessive sedation and weakness • Often poorly tolerated in older adults

• NSAID that produces the most CNS adverse effects

• Significant number of asymptomatic GI pathologic conditions Greater risk for: • GI bleeding • Renal failure • Hypertension • Heart failure • Not as effective as oral analgesics in commonly prescribed dosages • May cause confusion, seizures • Cases more CNS adverse effects than other opioid analgesics (e.g., confusion and hallucinations) • May cause dependence • Cardiovascular risks: hypertension, angina, myocardial infarction

In McKenry LM, Tessier E, Hogan MA: Mosby’s pharmacology in nursing, ed 22, St. Louis, 2006, Mosby. Modified from Fick DM, Cooper JW, Wade WE, et al: Updating the Beers criteria for potentially inappropriate medication use in older adults, Archives of Internal Medicine 163(22):2716-2724, 2003.

Copyright © 2010 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

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