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Drugs: High Potential for Severe Outcomes Elderly Cheat Sheet by

Drugs: High Potential for Severe Outcomes Elderly
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High Potential for Severe Outcomes

Drug
Desc­rip­tion
Psyc­hot­rop­ics
Amitri­ptyline (Elavil)
Strongly antich­oli­nergic and sedating
Barbit­urates
More side effects than most sedati­ve-­hyp­notic drugs; should not be used except to control seizures (pheno­bar­bital)
Long-a­cting benzod­iaz­epines
Long half-life and, hence, prolonged sedation; associated with an increased incidence of falls and fractures
Doxepin (Sinequan)
Strongly antich­oli­nergic and sedating
Meprob­amate (Miltown)
Highly addictive and sedating
Anal­ges­ics
Meperidine (Demerol)
Not effective when admini­stered orally; metabolite has antich­oli­nergic profile
Pentaz­ocine (Talwin)
Confusion and halluc­ina­tions more common than with other narcotics
Misc­ell­ane­ous
Antisp­asmodic agents (gastr­oin­tes­tinal)
Highly antich­oli­nergic with associated toxic effects
Chlorp­rop­amide (Diabi­nase)
Serious hypogl­ycemia possible because of the drug's prolonged half-life
Digoxin (Lanoxin)
Decreased renal clearance; doses should rarely exceed 0.125 mg except when treating arrhythmia
Methyldopa (Aldomet)
Causes bradyc­ardia and exacer­bates depression
Ticlop­idine (Ticlid)
More toxic than aspirin
Inform­ation from Beers M. Explicit criteria for determ­ining potent­ially inappr­opriate medication use by the elderly. An update. Arch Intern Med 1997;1­57:­1531–6.

Drugs Not to Be Used in Nursing Homes

Barb­itu­rates
Amobar­bital (Amytal)
Amobar­bit­al-­sec­oba­rbital (Tuinal)
Aspiri­n-b­uta­lbi­tal­-ca­ffeine (Fiorinal)
Butaba­rbital (Butisol)
Pentob­arbital (Nembutal)
Secoba­rbital (Seconal)
Other tranqu­ili­zers
Ethclo­rvynol (Placidyl)
Glutet­himide (Doriden)
Meprob­amate (Miltown)
 

High Potential for Less Severe Outcomes

Drug
Desc­rip­tion
Anal­ges­ics
Indome­thacin (Indocin)
More central nervous system side effects than any other nonste­roidal anti-i­nfl­amm­atory drug
Propox­yphene (Darvon)
Few advantages over acetam­inophen and has narcotic side effects
Anti­hyp­ert­ens­ives
Beta blockers
Can cause problems in patients with asthma or chronic obstru­ctive pulmonary disease; may precip­itate syncope because of negative inotropic and chrono­tropic effects
Reserpine*
Can cause depres­sion, sedation and orthos­tatic hypote­nsion
Misc­ell­ane­ous
Antihi­sta­mines†
Highly antich­oli­nergic
Cyclan­delate (Cyclo­spa­smol)
Generally ineffe­ctive for dementia or any other condition
Dipyri­damole (Persa­ntine)
Frequently causes orthos­tatic hypote­nsion; of benefit only in patients with artificial heart valves
Ergoloid mesylates (Hyder­gine)
Generally ineffe­ctive for dementia or any other condition
Muscle relaxants
Increased cholin­ergic activity, sedation and weakness
Trimet­hob­enz­amide (Tigan)
Least effective antiemetic and can cause extrap­yra­midal symptoms
*—Rese­rpine is available alone (in generic form) and is also found in combin­ation drugs such as reserp­ine­-tr­ich­lor­met­hiazide (Metat­ensin).
†—Over­-th­e-c­ounter and prescr­iption first-­gen­eration antihi­sta­mines.
Inform­ation from Beers M. Explicit criteria for determ­ining potent­ially inappr­opriate medication use by the elderly. An update. Arch Intern Med 1997;1­57:­1531–6.

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