DOCSLIB.ORG

Potentially Inappropriate Medications in Older Adults According the Beers

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Potentially Inappropriate Medications in Older Adults According the Beers Potentially Inappropriate Medications in Older Adults According to Beers List and STOPP Criteria Note: These guidelines are not applicable in all circumstances. Avoid use when possible. Use with caution when necessary. CENTRAL NERVOUS SYSTEM CARDIOVASCULAR Beers List Beers List Anticholinergic Antidepressants (alone or in combination): Peripheral Alpha-1 Blockers: Amitriptyline, amoxapine, clomipramine, desipramine, doxepin (> 6 Doxazosin, Prazosin, Terazosin mg/d) imipramine, nortriptyline, paroxetine, protriptyline, trimipramine Central Alpha Agonists: Antipsychotics – 1st (conventional) & 2nd (atypical) generation: Clonidine for first-line treatment of hypertension (HTN) Avoid except in schizophrenia, bipolar or short-term use as antiemetic Other CNS alpha-agonists: during chemotherapy. Guanabenz Increase risk of CVA, increase rate of cognitive decline and mortality in Methyldopa people with dementia. Guanfacine Barbiturates: Reserpine (> 0.1 mg/d) Amobarbital, butabarbital, butalbital, mephobarbital, pentobarbital, Others: phenobarbital, secobarbital Disopyramide Benzodiazepines (BZDs): Dronedarone, amiodarone Short- and intermediate-acting: alprazolam, estazolam, lorazepam, Digoxin (for first-line treatment of atrial fibrillation or of heart failure) oxazepam, temazepam, triazolam Nifedipine (immediate release form) Long-acting BZDs: clorazepate, chlordiazepoxide (alone or in Acetylcholinerase inhibiters combination with amitriptyline or clidinium), clonazepam, diazepam, Tertiary tricyclic antipsychotics flurazepam, quazepam Antipsychotics: Chlorpromazine Non-BZD “Z” Drugs: Thioridazine Eszopiclone, zaleplon, zolpidem Olanzapine Others: Meprobamate, ergoloid, mesylates, isoxsuprine Trimethoprim-sulfamethoxazole (with ACE inhibitor or ARB and decreased creatinine clearance) STOPP Criteria In patients with heart failure: Tricyclic antidepressants: NSAIDs, COX-2 inhibitors, non-dihydropyridine calcium channel In patients with dementia blockers, thiazolidinediones, cilostazol, dronederone First line for depression STOPP Criteria SSRIs with Na Centrally acting anti-hypertensives: Neuroleptics: Methyldopa With anticholinergic s/e Clonidine For behavior in dementia Used as hypnotics Guanfacine Antipsychotics in Parkinsonism or Lewy Body disease: Loop diuretic for: (except quetiapine and clozapine) HTN first-line Dependent ankle edema Benzodiazepines: HTN with urinary incontinence Used > 4 weeks Others: Anticholinergic/Antimuscarinics: In dementia or delirium Digoxin for heart failure Used to treat EPS of neuroleptic medications Diltiazem and Verapamil in New York Heart Association (NYHA) class 3-4 heart failure Phenothiazines: Beta blockers when heart rate less than 50 beats/min As first-line treatment Amiodarone first-line for supraventricular tachycardia (SVT) Levodopa or Dopamine: Agonists used for benign essential tremor ENDOCRINE DRUGS THAT INCREASE RISK OF FALLS Beers List Beers List Androgens: Anticonvulsants Methyltestosterone Antipsychotics Testosterone Benzodiazepines Desiccated thyroid: Tricyclic antidepressants (TCAs) Estrogens with or without progestines (oral or transdermal – Serotonin reuptake inhibitors (SSRIs) excludes intravaginal estrogen) Serotonin norepinephrine reuptake inhibitors (SNRIs) Growth hormone Opioids Sliding scale insulin: Non-benzodiazepine, benzodiazepine receptor agonists (Non-BZD “Z” Insulin regimens containing only short- or rapid-acting insulin drugs): dosed according to current blood glucose levels without Eszopiclone concurrent use of basal or long-acting insulin Zaleplon Long-acting Sulfonylureas: Zolpidem Chlorpropamide Glimepiride STOPP Criteria Glyburide (aka glibenclamide) Benzodiazepines (BZDs) STOPP Criteria Neuroleptic drugs Sulfonylureas with prolonged duration of action in type 2 diabetes Vasodilator drugs with persistent postural hypotension: mellitus: Alpha-1 receptor blockers ū Chlorpropamide Calcium channel blockers ū Glimepiride Nitrates (long-acting) Thiazolidenediones in persons with heart failure ACE inhibitors ū Rosiglitazone ARBs ū Pioglitazone Minoxidil Beta blockers in persons with diabetes mellitus with frequent Hydralazine hypoglycemic episodes Hypnotic Non-benzodiazepine, benzodiazepine receptor agonists Estrogens in people with history of breast cancer or venous (Non-BZD “Z” drugs): thromboembolism Eszopiclone Estrogens without progesterone in women with an intact uterus Zaleplon Androgens in the absence of primary or secondary hypogonadism Zolpidem ANALGESICS MUSCULOSKELETAL Beers List Beers List Non-cyclooxygenase-2 (Non-COX-2) NSAIDs: Carisoprodol, cyclobenzaprine, chlorzoxazone, metaxalone, Aspiring > 325 mg/day, diclofenac, diflunisal, etodolac, fenoprofen, methocarbamol, orphenadrine ibuprofen, ketoprofen, meclofenomate, mefenamic acid, meloxicam, nabumetone naproxen, oxaprozin, piroxicam, sulindac, tolmetin, STOPP Criteria indomethacin, ketorolac (includes parenteral) Non-COX-2 selective NSAIDs without concurrent proton pump Other: inhibitor (PPI) or H2 antagonist in persons with history of peptic Meperidine ulcer disease or gastrointestinal bleeding NSAID with established hypertension or heart failure STOPP Criteria Long-term use of NSAIDs (> 3 months) for relief of osteoarthritis Use of oral or transdermal “strong” opioids as first-line therapy for symptom pain where paracetamol has not been tried (use simple mild pain: analgesics first) ū Morphine Long-term corticosteroid use (> 3 months) as monotherapy for ū Oxycodone rheumatoid arthritis ū Fentanyl Oral corticosteroid use for osteoarthritis ū Buprenorphine Long-term NSAID or colchicine use for prevention of gout relapse ū Methadone (use xanthine-oxidase inhibitors first-line if not contraindicated) ū Tramadol COX-2 NSAIDs in concurrent cardiovascular disease Use of regular, scheduled opioids without a scheduled laxative NSAID with corticosteroids without PPI Use of long-acting opioids without short-acting opioids for break- Oral bisphosphonates in persons with history of upper through pain gastrointestinal disease ANTICHOLINERGICS GASTROINTESTINAL AND GENITORURINARY Beers List Beers List – Gastrointestinal First Generation Antihistamines: Aspirin (> 325 mg) Brompheniramine, carbinoxamine, chlorpheniramine, clemastine, Non-COX-2 selective NSAIDS cyproheptadine, dexbrompheniramine, dexchlorpheniramine, Metoclopramide (unless for gastroparesis with duration of use not to dimenhydrinate, diphenhydramine (oral), doxylamine, hydroxyzine, exceed 12 weeks except in rare cases) meclizine, promethazine, pyrilamine, triprolidine Mineral oil, administered orally Antiparkinsonian Agents: PPIs (avoid scheduled use > 8 weeks unless person at high risk) Benztropine, trihexyphenidyl STOPP Criteria – Gastrointestinal Antispasmodics: Prochlorperazine or metoclopramide with Parkinsonian symptoms Atropine (excludes ophthalmic), belladonna alkaloids, clindinium- PPIs for uncomplicated peptic ulcer disease or erosive peptic chlordizepoxide, dicyclomine, homatopine (excludes ophthalmic), esophagitis at full therapeutic dosage for > 8 weeks hyoscyamine, methscopolamine, propantheline, scopolamine Drugs likely to cause constipation in persons with chronic Antidepressants: constipation where non-constipating alternatives are appropriate Amitriptyline, amoxapine, clomipramine, desipramine, doxepin (> 6mg), ū Antimuscarinic/anticholinergic drugs imipramine, nortriptyline, paroxetine, protriptyline, trimipramine ū Opioids Antimuscarinics: ū Verapamil Darifenacin, fesoterodine, flavoxate, oxybutinin, solifenacin, tolterodine, ū Aluminum antacids trospium Oral elemental iron doses greater than 200 mg/day – examples: ū Ferrous fumarate Antipsychotics: ū Ferrous gluconate Chlorpromazine, clozapine, loxapine, olanzapine, perphenazine, ū Ferrous sulfate thioridazine, trifluoperazine ū Polysaccharide-iron complex (PIC) Skeletal muscle relaxants: ū PIC plus folic acid Vitamin B12 Cyclobenzaprine, orphenadrine ū Antiarrhythmic: Beers List – Genitourinary Disopyramide Desmopressin for nocturia or nocturnal polyuria Antiemetics: Metoclopramide, prochloroperazine, promethazine STOPP Criteria – Genitourinary Selective alpha-1 blockers in persons with symptomatic orthostatic STOPP Criteria hypotension or micturition syncope Concomitant use of two or more drugs with antimuscarinic/ Antimuscarinic drugs for overactive bladder in persons with: anticholinergic properties – examples: ū Dementia or chronic cognitive impairment ū Bladder antispasmodics ū Narrow-angle glaucoma ū Intestinal antispasmodics ū Chronic prostatism ū Tricyclic antidepressants ū First generation antihistamines ANTITHROMBOTIC Beers List (Avoid) Aspirin: > 160 mg daily long-term use Dipyridamole – oral, short-acting (does not apply to the extended- With history of peptic ulcer disease without concomitant PPI release combination with aspirin) Plus clopidogrel as secondary stroke prevention Warfarin used with amiodarone Warfarin used with NSAIDs Vitamin K antagonist, direct thrombin inhibitor or factor Xa inhibitors: Warfarin used with ciprofloxacin With antiplatelet agents in patients with stable coronary, Warfarin used with macrolides (excluding azithromycin) cerebrovascular or peripheral arterial disease without a clear Warfarin used with trimethoprim-sulfamethoxazole indication for anticoagulant therapy In combination with aspirin in patients with chronic atrial Beers List (Use With Caution) fibrillation Aspirin for primary prevention of cardiac disease and colorectal cancer For > 6 months for
Load more

Recommended publications
  • Table 2. 2012 AGS Beers Criteria for Potentially
    Table 2. 2012 AGS Beers Criteria for Potentially Inappropriate Medication Use in Older Adults Strength of Organ System/ Recommendat Quality of Recomm Therapeutic Category/Drug(s) Rationale ion Evidence endation References Anticholinergics (excludes TCAs) First-generation antihistamines Highly anticholinergic; Avoid Hydroxyzin Strong Agostini 2001 (as single agent or as part of clearance reduced with e and Boustani 2007 combination products) advanced age, and promethazi Guaiana 2010 Brompheniramine tolerance develops ne: high; Han 2001 Carbinoxamine when used as hypnotic; All others: Rudolph 2008 Chlorpheniramine increased risk of moderate Clemastine confusion, dry mouth, Cyproheptadine constipation, and other Dexbrompheniramine anticholinergic Dexchlorpheniramine effects/toxicity. Diphenhydramine (oral) Doxylamine Use of diphenhydramine in Hydroxyzine special situations such Promethazine as acute treatment of Triprolidine severe allergic reaction may be appropriate. Antiparkinson agents Not recommended for Avoid Moderate Strong Rudolph 2008 Benztropine (oral) prevention of Trihexyphenidyl extrapyramidal symptoms with antipsychotics; more effective agents available for treatment of Parkinson disease. Antispasmodics Highly anticholinergic, Avoid Moderate Strong Lechevallier- Belladonna alkaloids uncertain except in Michel 2005 Clidinium-chlordiazepoxide effectiveness. short-term Rudolph 2008 Dicyclomine palliative Hyoscyamine care to Propantheline decrease Scopolamine oral secretions. Antithrombotics Dipyridamole, oral short-acting* May
    [Show full text]
  • Switching from Clonidine Immediate-Release to Guanfacine Extended-Release
    / DE L’ACADÉMIE CANADIENNE DE PSYCHIATRIE DE L’ENFANT ET DE L’ADOLESCENT PSYCHOPHARMACOLOGY Switching from Clonidine Immediate-Release to Guanfacine Extended-Release Dean Elbe PharmD, BCPP1,2,3 s a clinical pharmacy specialist in child and adolescent (Canada) Ltd, 2012b). Clonidine has been used off-label Amental health, I am frequently asked how to switch in children for many years for treatment of insomnia, patients from clonidine immediate-release (IR) to guanfa- ADHD, and disruptive behaviour disorders (Hunt, Capper cine extended-release (XR). This therapeutic switch may be & O’Connell, 1990; Rubinstein; Jaselskis, Cook, Fletcher required when poor adherence to a clonidine IR regimen & Leventhal, 1992; Silver & Licamele, 1994; Palumbo et (typically requiring 3–4 doses daily) is identified, when al., 2008; Efron, Lycett & Sciberras, 2014). A clonidine XR clonidine dose-optimization is limited by sedation, brady- formulation is not available in Canada, but is available in cardia or hypotension, or when coverage situations change. the United States for treatment of ADHD (Concordia Phar- The latter may occur if, for example, new eligibility for a maceuticals, Inc. 2015). government program or a third party-payer occurs. Weight-based dosing guidelines exist for clonidine IR Guanfacine XR, a selective alpha2A agonist, was first mar- (0.003–0.008 mg/kg/day) and guanfacine XR (0.05–0.08 keted in Canada in late 2013 for the treatment of attention mg/kg/day) (Shire Pharma Canada ULC, 2019; Elbe et deficit hyperactivity disorder (ADHD) in children and ado- al., 2018). Based on these guidelines and other literature, lescents (Shire Pharma Canada ULC, 2019).
    [Show full text]
  • Optum Essential Health Benefits Enhanced Formulary PDL January
    PENICILLINS ketorolac tromethamineQL GENERIC mefenamic acid amoxicillin/clavulanate potassium nabumetone amoxicillin/clavulanate potassium ER naproxen January 2016 ampicillin naproxen sodium ampicillin sodium naproxen sodium CR ESSENTIAL HEALTH BENEFITS ampicillin-sulbactam naproxen sodium ER ENHANCED PREFERRED DRUG LIST nafcillin sodium naproxen DR The Optum Preferred Drug List is a guide identifying oxacillin sodium oxaprozin preferred brand-name medicines within select penicillin G potassium piroxicam therapeutic categories. The Preferred Drug List may piperacillin sodium/ tazobactam sulindac not include all drugs covered by your prescription sodium tolmetin sodium drug benefit. Generic medicines are available within many of the therapeutic categories listed, in addition piperacillin sodium/tazobactam Fenoprofen Calcium sodium to categories not listed, and should be considered Meclofenamate Sodium piperacillin/tazobactam as the first line of prescribing. Tolmetin Sodium Amoxicillin/Clavulanate Potassium LOW COST GENERIC PREFERRED For benefit coverage or restrictions please check indomethacin your benefit plan document(s). This listing is revised Augmentin meloxicam periodically as new drugs and new prescribing LOW COST GENERIC naproxen kit information becomes available. It is recommended amoxicillin that you bring this list of medications when you or a dicloxacillin sodium CARDIOVASCULAR covered family member sees a physician or other penicillin v potassium ACE-INHIBITORS healthcare provider. GENERIC QUINOLONES captopril ANTI-INFECTIVES
    [Show full text]
  • DESCRIPTION Tolazamide Is an Oral Blood-Glucose-Lowering Drug of the Sulfonylurea Class
    TOLAZAMIDE- tolazamide tablet PD-Rx Pharmaceuticals, Inc. ---------- DESCRIPTION Tolazamide is an oral blood-glucose-lowering drug of the sulfonylurea class. Tolazamide is a white or creamy-white powder very slightly soluble in water and slightly soluble in alcohol. The chemical name is 1-(Hexahydro-1 H-azepin-1-yl)-3-( p-tolylsulfonyl)urea. Tolazamide has the following structural formula: Each tablet for oral administration contains 250 mg or 500 mg of tolazamide, USP and the following inactive ingredients: colloidal silicon dioxide, croscarmellose sodium, magnesium stearate, microcrystalline cellulose, and sodium lauryl sulfate. CLINICAL PHARMACOLOGY Actions Tolazamide appears to lower the blood glucose acutely by stimulating the release of insulin from the pancreas, an effect dependent upon functioning beta cells in the pancreatic islets. The mechanism by which tolazamide lowers blood glucose during long-term administration has not been clearly established. With chronic administration in type II diabetic patients, the blood glucose-lowering effect persists despite a gradual decline in the insulin secretory response to the drug. Extrapancreatic effects may be involved in the mechanism of action of oral sulfonylurea hypoglycemic drugs. Some patients who are initially responsive to oral hypoglycemic drugs, including tolazamide tablets, may become unresponsive or poorly responsive over time. Alternatively, tolazamide tablets may be effective in some patients who have become unresponsive to one or more other sulfonylurea drugs. In addition to its blood glucose-lowering actions, tolazamide produces a mild diuresis by enhancement of renal free water clearance. Pharmacokinetics Tolazamide is rapidly and well absorbed from the gastrointestinal tract. Peak serum concentrations occur at 3 to 4 hours following a single oral dose of the drug.
    [Show full text]
  • MSM Cross Reference Antihistamine Decongestant 20100701 Final Posted
    MISSISSIPPI DIVISION OF MEDICAID Antihistamine/Decongestant Product and Active Ingredient Cross-Reference List The agents listed below are the antihistamine/decongestant drug products listed in the Mississippi Medicaid Preferred Drug List (PDL). This is a cross-reference between the drug product name and its active ingredients to reference the antihistamine/decongestant portion of the PDL. For more information concerning the PDL, including non- preferred agents, the OTC formulary, and other specifics, please visit our website at www.medicaid.ms.gov. List Effective 07/16/10 Therapeutic Class Active Ingredients Preferred Non-Preferred ANTIHISTAMINES - 1ST GENERATION BROMPHENIRAMINE MALEATE BPM BROMAX BROMPHENIRAMINE MALEATE J-TAN PD BROMSPIRO LODRANE 24 LOHIST 12HR VAZOL BROMPHENIRAMINE TANNATE BROMPHENIRAMINE TANNATE J-TAN P-TEX BROMPHENIRAMINE/DIPHENHYDRAM ALA-HIST CARBINOXAMINE MALEATE CARBINOXAMINE MALEATE PALGIC CHLORPHENIRAMINE MALEATE CHLORPHENIRAMINE MALEATE CPM 12 CHLORPHENIRAMINE TANNATE ED CHLORPED ED-CHLOR-TAN MYCI CHLOR-TAN MYCI CHLORPED PEDIAPHYL TANAHIST-PD CLEMASTINE FUMARATE CLEMASTINE FUMARATE CYPROHEPTADINE HCL CYPROHEPTADINE HCL DEXCHLORPHENIRAMINE MALEATE DEXCHLORPHENIRAMINE MALEATE DIPHENHYDRAMINE HCL ALLERGY MEDICINE ALLERGY RELIEF BANOPHEN BENADRYL BENADRYL ALLERGY CHILDREN'S ALLERGY CHILDREN'S COLD & ALLERGY COMPLETE ALLERGY DIPHEDRYL DIPHENDRYL DIPHENHIST DIPHENHYDRAMINE HCL DYTUSS GENAHIST HYDRAMINE MEDI-PHEDRYL PHARBEDRYL Q-DRYL QUENALIN SILADRYL SILPHEN DIPHENHYDRAMINE TANNATE DIPHENMAX DOXYLAMINE SUCCINATE
    [Show full text]
  • Understanding Benzodiazephine Use, Abuse, and Detection
    Siemens Healthcare Diagnostics, the leading clinical diagnostics company, is committed to providing clinicians with the vital information they need for the accurate diagnosis, treatment and monitoring of patients. Our comprehensive portfolio of performance-driven systems, unmatched menu offering and IT solutions, in conjunction with highly responsive service, is designed to streamline workflow, enhance operational efficiency and support improved patient care. Syva, EMIT, EMIT II, EMIT d.a.u., and all associated marks are trademarks of General Siemens Healthcare Diagnostics Inc. All Drugs other trademarks and brands are the Global Division property of their respective owners. of Abuse Siemens Healthcare Product availability may vary from Diagnostics Inc. country to country and is subject 1717 Deerfield Road to varying regulatory requirements. Deerfield, IL 60015-0778 Please contact your local USA representative for availability. www.siemens.com/diagnostics Siemens Global Headquarters Global Siemens Healthcare Headquarters Siemens AG Understanding Wittelsbacherplatz 2 Siemens AG 80333 Muenchen Healthcare Sector Germany Henkestrasse 127 Benzodiazephine Use, 91052 Erlangen Germany Abuse, and Detection Telephone: +49 9131 84 - 0 www.siemens.com/healthcare www.usa.siemens.com/diagnostics Answers for life. Order No. A91DX-0701526-UC1-4A00 | Printed in USA | © 2009 Siemens Healthcare Diagnostics Inc. Syva has been R1 R2 a leading developer N and manufacturer of AB R3 X N drugs-of-abuse tests R4 for more than 30 years. R2 C Now part of Siemens Healthcare ® Diagnostics, Syva boasts a long and Benzodiazepines have as their basic chemical structure successful track record in drugs-of-abuse a benzene ring fused to a seven-membered diazepine ring. testing, and leads the industry in the All important benzodiazepines contain a 5-aryl substituent ring (ring C) and a 1,4–diazepine ring.
    [Show full text]
  • Anticholinergic Drugs Improve Symptoms but Increase Dry Mouth in Adults with Overactive Bladder Syndrome
    Source of funding: Evid Based Nurs: first published as 10.1136/ebn.6.2.49 on 1 April 2003. Downloaded from Review: anticholinergic drugs improve symptoms but Health Research Council of Aotearoa increase dry mouth in adults with overactive bladder New Zealand. syndrome For correspondence: Jean Hay-Smith, Hay-Smith J, Herbison P,Ellis G, et al. Anticholinergic drugs versus placebo for overactive bladder syndrome in adults. Dunedin School of Cochrane Database Syst Rev 2002;(3):CD003781 (latest version May 29 2002). Medicine, University of Otago, Dunedin, New QUESTION: What are the effects of anticholinergic drugs in adults with overactive Zealand. jean.hay-smith@ bladder syndrome? otago.ac.nz Data sources Parallel arm studies of anticholinergic drugs v placebo for overactive bladder syndrome in Studies were identified by searching the Cochrane adults at 12 days to 12 weeks* Incontinence Group trials register (to January 2002) Weighted event rates and reference lists of relevant papers. Anticholinergic Study selection Outcomes drugs Placebo RBI (95% CI) NNT (CI) Randomised or quasi-randomised controlled trials in Self reported cure or adults with symptomatic diagnosis of overactive bladder improvement (8 studies) 63% 45% 41% (29 to 54) 6 (5 to 8) syndrome, urodynamic diagnosis of detrusor overactiv- RRI (CI) NNH (CI) ity, or both, that compared an anticholinergic drug Dry mouth (20 studies) 36% 15% 138 (70 to 232) 5 (4 to 7) (given to decrease symptoms of overactive bladder) with Outcomes Weighted mean difference (CI) placebo or no treatment. Studies of darifenacin, emepronium bromide or carrageenate, dicyclomine Number of leakage episodes in 24 hours (9 − chloride, oxybutynin chloride, propiverine, propanthe- studies) 0.56 (–0.73 to –0.39) Number of micturitions in 24 hours (8 studies) −0.59 (–0.83 to –0.36) line bromide, tolterodine, and trospium chloride were Maximum cystometric volume (ml) (12 studies) 54.3 (43.0 to 65.7) included.
    [Show full text]
  • Drug Therapy in Older Adults
    Interprofessional Geriatrics Training Program Drug Therapy in Older Adults HRSA GERIATRIC WORKFORCE ENHANCEMENT FUNDED PROGRAM Grant #U1QHP2870 EngageIL.com Acknowledgements Author: Michael Koronkowski, PharmD, CGP Contributor: Joseph T. Hanlon, PharmD, MS Editors: Valerie Gruss, PhD, APN, CNP-BC Memoona Hasnain, MD, MHPE, PhD Expert Interviewee: Todd Semla, MS, PharmD, BCPS, FCCP, AGSF Case: Medication Therapy in Older Adults • Mrs. Roberts is a 77-year-old widow who lives alone • She has multiple medical problems, which include: chronic obstructive pulmonary disease (COPD), hypertension (HTN), diabetes (DM), coronary artery disease (CAD), cerebral vascular accident (CVA), osteoporosis, osteoarthritis, gastroesophageal reflux disease (GERD), anxiety, insomnia, allergic rhinitis, glaucoma, multiple falls at home, and currently smokes 4 cigarettes/day • Though she has prescription insurance (Medicare Part D), she has difficulty affording her monthly copayments • She tries to take her medications as prescribed, but she misses doses Case: Medication Therapy in Older Adults • She is currently taking 21 medications, which include: • Budesonide/formoterol, albuterol, amlodipine, insulin glargine, insulin aspart, sitagliptin, alendronate, acetaminophen, diclofenac gel, glucosamine, meclizine, omeprazole, mirtazapine, zolpidem, trazodone, diphenhydramine, fluticasone, estrogen vaginal cream, triamcinolone cream, and timolol eye drops Learning Objectives Upon completion of this module, learners will be able to: 1. Recognize the common consequences of inappropriate medication use and polypharmacy 2. Describe the key principles of pharmacology and the effects of age on medication use 3. Summarize the main approaches to improve medication prescribing and monitoring 4. Describe a stepwise approach to integrating into practice a process for prescribing and monitoring medications 5. Identify provider and patient resources to support drug prescribing and monitoring medications Case: Medication Therapy in Older Adults Mrs.
    [Show full text]
  • Product Information
    PRODUCT INFORMATION NAME OF THE MEDICINE POLARAMINE® (dexchlorpheniramine maleate) DESCRIPTION Polaramine (dexchlorpheniramine maleate) is the dextro-isomer of chlorpheniramine maleate. It is an antihistamine with anticholinergic properties Dexchlorpheniramine maleate (CAS no. 2438-32-6) is described chemically as (+)-2-[p- chloro-α-[2-(dimethylamino)ethyl]benzyl]pyridine maleate (1:1). It has the empirical formula of C16H19ClN2.C4H4O4 and the following structural formula: Dexchlorpheniramine maleate is a white, odourless, crystalline powder which in aqueous solution has a pH of between 4 and 5. It is freely soluble in water, soluble in alcohol and in chloroform, but only slightly soluble in benzene or ether. PHARMACOLOGY Pharmacodynamics Mechanism of Action: Dexchlorpheniramine, the d-isomer of the racemic compound chlorpheniramine, is two times more active than chlorpheniramine. Dexchlorpheniramine does not prevent the release of histamine, but rather, competes with free histamine for binding at the H1-receptor sites, and competitively antagonizes the effects of histamine on H1-receptors in the GI tract, uterus, large blood vessels, and bronchial muscle. Blockade of H1-receptors also suppresses the formation of oedema, flare, and pruritus that result from histaminic activity. Since dexchlorpheniramine binds to central and peripheral H1-receptors, sedative effects are likely to occur. H1-antagonists are structurally similar to anticholinergic agents and therefore possess the potential to exhibit anticholinergic properties of varying
    [Show full text]
  • Report Update 1
    Drug Class Review on Newer Antihistamines Final Report Update 1 April 2006 Original Report Date: November 2004 A literature scan of this topic is done periodically The purpose of this report is to make available information regarding the comparative effectiveness and safety profiles of different drugs within pharmaceutical classes. Reports are not usage guidelines, nor should they be read as an endorsement of, or recommendation for, any particular drug, use or approach. Oregon Health & Science University does not recommend or endorse any guideline or recommendation developed by users of these reports. Oregon Evidence-based Practice Center Oregon Health & Science University Mark Helfand, MD, MPH, Director Copyright © 2006 by Oregon Health & Science University Portland, Oregon 97201. All rights reserved. Note: A scan of the medical literature relating to the topic is done periodically (see http://www.ohsu.edu/ohsuedu/research/policycenter/DERP/about/methods.cfm for scanning process description). Upon review of the last scan, the Drug Effectiveness Review Project governance group elected not to proceed with another full update of this report. Some portions of the report may not be up to date. Prior version of this report can be accessed at the DERP website. Final Report Update #1 Drug Effectiveness Review Project TABLE OF CONTENTS INTRODUCTION.............................................................................................................................................................4 SCOPE AND KEY QUESTIONS.............................................................................................................................6
    [Show full text]
  • And Calcium, Magnesium, Potassium and Sodium Oxybates (Xywav™)
    Louisiana Medicaid Sodium Oxybate (Xyrem®) and Calcium, Magnesium, Potassium and Sodium Oxybates (Xywav™) The Louisiana Uniform Prescription Drug Prior Authorization Form should be utilized to request clinical authorization for sodium oxybate (Xyrem®) and calcium, magnesium, potassium and sodium oxybates (Xywav™). These agents have Black Box Warnings and are subject to Risk Evaluation and Mitigation Strategy (REMS) under FDA safety regulations. Please refer to individual prescribing information for details. Approval Criteria • The recipient is 7 years of age or older on date of request; AND • The recipient has a documented diagnosis of narcolepsy or cataplexy; AND • The prescribing provider is a Board-Certified Neurologist or a Board-Certified Sleep Medicine Physician; AND • By submitting the authorization request, the prescriber attests to the following: o The prescribing information for the requested medication has been thoroughly reviewed, including any Black Box Warning, Risk Evaluation and Mitigation Strategy (REMS), contraindications, minimum age requirements, recommended dosing, and prior treatment requirements; AND o All laboratory testing and clinical monitoring recommended in the product prescribing information have been completed as of the date of the request and will be repeated as recommended; AND o The recipient has no inappropriate concomitant drug therapies or disease states. Duration of initial authorization approval: 3 months Reauthorization Criteria • The recipient continues to meet all initial approval criteria; AND
    [Show full text]
  • Prescription Drug Management
    Check out our new site: www.acllaboratories.com Prescription Drug Management Non Adherence, Drug Misuse, Increased Healthcare Costs Reports from the Centers for DiseasePrescription Control and Prevention (CDC) say Drug deaths from Managementmedication overdose have risen for 11 straight years. In 2008 more than 36,000 people died from drug overdoses, and most of these deaths were caused by prescription Nondrugs. Adherence,1 Drug Misuse, Increased Healthcare Costs The CDC analysis found that nearly 40,000 drug overdose deaths were reported in 2010. Prescribed medication accounted for almost 60 percent of the fatalities—far more than deaths from illegal street drugs. Abuse of painkillers like ReportsOxyContin from and the VicodinCenters forwere Disease linked Control to the and majority Prevention of the (CDC) deaths, say deaths from according to the report.1 medication overdose have risen for 11 straight years. In 2008 more than 36,000 people died from drug overdoses, and most of these deaths were caused by prescription drugs. 1 A health economics study analyzed managed care claims of more than 18 million patients, finding that patients undergoing opioid therapyThe CDCfor chronic analysis pain found who that may nearly not 40,000 be following drug overdose their prescription deaths were regimenreported in 2010. Prescribed medication accounted for almost 60 percent of the fatalities—far more than deaths have significantly higher overall healthcare costs. from illegal street drugs. Abuse of painkillers like OxyContin and Vicodin were linked to the majority of the deaths, according to the report.1 ACL offers drug management testing to provide information that can aid clinicians in therapy and monitoring to help improve patientA health outcomes.
    [Show full text]