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Paper Clip—High Risk Medications

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Paper Clip—High Risk Medications You belong. PAPER CLIP—HIGH RISK MEDICATIONS Description: Some medications may be risky for people over 65 years of age and there may be safer drug choices to treat some conditions. It is recommended that medications are reviewed regularly with your providers/prescriber to ensure patient safety. Condition Treated Current Medication(s)-High Risk Safer Alternatives to Consider Urinary Tract Infections (UTIs), Nitrofurantoin Bactrim (sulfamethoxazole/trimethoprim) or recurrent UTIs, or Prophylaxis (Macrobid, or Macrodantin) Trimpex/Proloprim/Primsol (trimethoprim) Allergies Hydroxyzine (Vistaril, Atarax) Xyzal (Levocetirizine) Anxiety Hydroxyzine (Vistaril, Atarax) Buspar (Buspirone), Paxil (Paroxetine), Effexor (Venlafaxine) Parkinson’s Hydroxyzine (Vistaril, Atarax) Symmetrel (Amantadine), Sinemet (Carbidopa/levodopa), Selegiline (Eldepryl) Motion Sickness Hydroxyzine (Vistaril, Atarax) Antivert (Meclizine) Nausea & Vomiting Hydroxyzine (Vistaril, Atarax) Zofran (Ondansetron) Insomnia Hydroxyzine (Vistaril, Atarax) Ramelteon (Rozerem), Doxepin (Silenor) Chronic Insomnia Eszopiclone (Lunesta) Ramelteon (Rozerem), Doxepin (Silenor) Chronic Insomnia Zolpidem (Ambien) Ramelteon (Rozerem), Doxepin (Silenor) Chronic Insomnia Zaleplon (Sonata) Ramelteon (Rozerem), Doxepin (Silenor) Muscle Relaxants Cyclobenazprine (Flexeril, Amrix) NSAIDs (Ibuprofen, naproxen) or Hydrocodone Codeine Tramadol (Ultram) Baclofen (Lioresal) Tizanidine (Zanaflex) Migraine Prophylaxis Elavil (Amitriptyline) Propranolol (Inderal), Timolol (Blocadren), Topiramate (Topamax), Valproic Acid (Depakote), Divalproex (Depakote ER) Depression Elavil (Amitriptyline) Paroxetine (Paxil), Sertraline (Zoloft), Venlafaxine (Effexor), Duloxetine (Cymbalta), Citalopram (Celexa), Escitalopram (Lexapro), Fluoxetine (Prozac), Trazodone(Oleptro) Anxiety Elavil (Amitriptyline) Paroxetine (Paxil), Venlafaxine (Effexor), Duloxetine (Cymbalta), Buspirone (Buspar) Schizophrenia Elavil (Amitriptyline) Olanzapin (Zyprexa), Quetiapine(Seroquel), Risperidone(Risperdal), Ziprasidone (Geodon) Post Herpetic Neuralgia Elavil (Amitriptyline) Gabapentin (Neurontin), Pregabalin (Lyrica) Postmenopausal Symptoms Estadiol/Noreth AC (Combi-patch, Estradiol Acetate(Femring),Estradiol Vaginal Cream Mimvey, Activella); Estradiol/Norgestimate (Estrace Vaginal Cream); Conjugated Estrogens (Prefest, Ortho-Prefest); Conjugated Vaginal Cream(Premarin Vaginal Cream); Estradiol Estrogens (Cenestin, Enjuvia); Esterified Vaginal Tablets(Vagifem) Estrogens (Menefest) Osteoporosis Estadiol/Noreth AC (Combi-patch, Alendronate(Fosamax); Ibandronate (Fosamax); Mimvey, Activella); Estradiol/Norgestimate Raloxifene(Evista) (Prefest, Ortho-Prefest); Conjugated Estrogens (Cenestin, Enjuvia); Esterified Estrogens (Menefest) Conversation with Member: • General opening such as: “How are you doing with taking your medications? Have you had an opportunity to discuss your medications with your doctor or pharmacist lately?” • Offer information: “Some medications may be risky for people over 65; can we talk about your prescriptions today?” • Get more specific: “Are you still taking (see risky med column above)? Did you know that there may be a greater risk with that medication with age? There are other medications that can be used to treat your (see list above) with less risk for complications, such as (see less risky med list above). It is probably a good time to learn about safer alternatives with your doctor.” • Lifestyle impacts: “Taking your medications as prescribed is important, but you should also be aware of safer medication options.” • Medical treatment: “Your doctor or pharmacist can meet with you to discuss your current prescriptions and review options of some safer alternatives to (see risky med list below).” • Review the member’s plan of action: “Let’s review your plan to ensure that you are taking medications with a minimum risk for you.” • National Standard: Priority Gap for HEDIS & Stars: Plan Members 65 and older who received prescriptions for certain drugs with a high risk of side effects, when there may be safer drug choices. References: Dipiro JT, et al. Pharmacotherapy: a pathophysiologic approach, 7th Ed. New York. McGraw-Hill. 2008. © 2015 Medica. Medica® is a registered service mark of Medica Health Plans. “Medica” refers to the family of health plan businesses that includes Medica Health Plans, Medica Health Plans of Wisconsin, Medica Insurance Company, Medica Self-Insured, and Medica Health Management, LLC..
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