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Beers Criteria Flashcards

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1
Q

antihistamines to avoid

A

1st generation:
benadryl
brompheniramine, chlorpheniramine
cyproheptadine
dimenhydrinate
doxylamine
hydroxyzine
promethazine
meclizine

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2
Q

antihistamine harms

A

dry mouth
constipation
falls, delirium, dementia

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3
Q

infective agents to avoid

A

nitrofurantoin -pulmonary toxicity, hepatotoxicity, peripheral neuropathy avoid in CrCl <30ml/min

bactrim - kidney damage, hyperK

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4
Q

avoid which blood thinners?

A

warfarin - DOAC’s are better
ASA - unless for 2nd prevention, don’t use
rivaroxaban - higher bleed risk than other DOACs
dipyridamole - orthostatic hypotension

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5
Q

avoid which HTN meds?

A

a1 blockers - doxazosin, terazosin, prazosin, clonidine, guanfacine
nifedipine IR - hypoTN

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6
Q

which heart meds to avoid?

A

amiodarone - avoid 1st line unless HF or LVH due to more ADR than other agents

dronedarone - avoid in permanent Afib or HF - worse ADR than others

digoxin - avoid >0.125mg/day - safer meds on the market

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7
Q

avoid which antidepressants?

A

amitriptyline, desipramine, doxepin >6mg/day, imipramine, nortriptyline, paroxetine

highly anticholinergic

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8
Q

which anti-parkinson’s to avoid?

A

benztropine and trihexyphenidyl

too many extrapyramidal symptoms

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9
Q

which anti-psychotics to avoid?

A

aripiprazole, haloperidol, olanzapine quetiapine, risperidone - increased risk of stroke, more cognitive decline and mortality than others

phenobarbital/primidone - physical dependence, greater risk of OD

benzos - avoid if possible

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10
Q

avoid which sleep drugs

A

benadryl - anticholinergic

lunesta/zolpidem/benzos - OD, delirium, falls, fractures

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11
Q

avoid which hormones?

A

testosterone and estrogen increased cardiac risk and hormonal cancers

megestrol - increased thrombotic events

growth

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12
Q

avoid which anti-diabetic agents?

A

insulin, sulfonylureas, SGLT2’s

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13
Q

avoid which GI meds?

A

PPIs - increased risk of cdiff, PNA, GI malignancy, bone loss and fx

metoclopramide - extrapyramidal, TD

atropine, clidinium/chlordizepoxide, dicyclomine, hyoscyamine, scopolamine - too anticholinergic

mineral oil PO - aspiration risks

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14
Q

avoid which pain meds?

A

regular NSAIDs, indomethacin, ketorolac- bleed risk
meperidine - neurotoxicity
muscle relaxers (flexeril, methocarbamol, carisoprodol) - anticholinergic ADR (baclofen and tizanidine best)

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15
Q

avoid which meds in HF

A

cilostazol, diltiazem, verapamil, dextromethorphan/quinindine, NSAIDs, pioglitazones

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16
Q

best antiplatelet med

A

clopidogrel

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17
Q

best muscle relaxer

A

tizanidine or baclofen

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18
Q

SSRI to avoid

A

paroxetine

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19
Q

slowed GI motility increases risk of ulceration by which meds?

A

NSAIDs
bisphosphonates
potassium chloride

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20
Q

decreased first pass metabolism increases [x] of which meds?

A

morphine
propranolol

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21
Q

Geriatric Depression Scale

A

0 - 5 is normal
>5 thorough psych evaluation

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22
Q

MMSE/SLUMS Scores

A

0 to 30 is the scoring
25+ is normal function
20 - 24 is mild dementia
13 - 19 is moderate dementia
<12 is severe dementia

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23
Q

causes of risk of falls

A

Vit D deficiency
poor balance, weakness
orthostatic hypotension
hypoglycemia, natremia
psychotic meds

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24
Q

Lewy Body dementia

A

avoid typical antipsychotics, may use cholinesterase inhibitors

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25
how to treat frontotemporal dementia
trazodone or SSRI's
26
donepezil
all levels of alzheimer's disease acetylcholinesterase inhibitors 5mg daily initially
27
rivastigmine
for alzheimer's disease and parkinson's disease acetylcholinesterase inhibitor 1.5mg PO BID or 4.6mg patch at 1st
28
galantamine
mild Alzheimer's acetylcholinesterase and nicotine 4mg BID or 8mg ER daily renal dose necessary, take with food
29
memantine
moderate to severe alzheimer's NMDA antagonist can be used with acetylcholinesterase inhibitors 5mg daily up to 10mg BID or 7mg ER
30
donepezil/memantine
may go to once stable on memantine and donepezil separately 10/28mg HS acetylcholinesterase and NMDA
31
cholinesterase inhibitor side effects
nausea, vomiting, diarrhea, elevated risk of GI bleeding HA, insomnia, dizziness bradycardia, orthostatic hypotension, syncope incontinence, anorexia, weight loss, falls, hip fx
32
tx for dementia in AD
mild - galantamine, donepezil, rivastigmine moderate - galantamine/donepezil/rianvastigmine, memantine, or both
33
anti-amyloid monoclonal antibodies
mild dementia or mild cognitive impairment q4w, very expensive iron overload, microhemorrhages in brain, edema of brain should get repeat MRI's PRN
34
problems geriatrics cannot verbalize
constipation - scheduled bowel regimen pain - scheduled tylenol
35
treat geriatrics for anxiety
buspirone SSRI/SNRI gabapentin limit benzos
36
treat geriatrics for apathy
cholinesterase inhibitors (donepezil, galantamine, rivastigmine) methylphenidate in small doses
37
treat geriatrics with depression
SSRI or mirtazapine no on paroxetine
38
treat geriatrics with insomnia
melatonin mirtazapine if depression also
39
treat geriatrics for paranoia, hallucinations, sundowning, agitation
risperidone, olanzapine, quetiapine, aripiprazole in low doses quetiapine is preferred in Parkinsons pimavanserin is only for parkinsons
40
how to treat geriatrics with aggression or resistance to care
valproic acid most common experimental for prazosin, nuedexta, citalopram
41
causes for urinary incontinence
DRIP drugs, delirium retention, restricted mobility impaction, infection, inflammation polyuria, prostatitis
42
drugs that cause urinary incontinence
bethanechol donepezil, rivastigmine, galantamine prazosin benadryl-like drugs, CCBs, opioids diuretics and sedation drugs
43
antimuscarinic agents
oxybutynin, tolterodine, fesoterodine, trospium, solifenacin, darifenacin BEERS list for anticholinergic activity
44
beta-3 agonists
mirabegron, vibegron minimal anticholinergic effects can be used with antimuscarinics do not use if HTN
45
alpha adrenergic antagonists for urinary incontinence
alfuzosin, tamsulosin, silodosin, doxazosin, terazosin, prazosin tamsulosin is preferred in geriatrics caution if cataract surgery soon, floppy iris syndrome
46
5a reductase inhibitors
finasteride, dutasteride reduce the size of the prostate and alter PSA values, slows progression reserve for prostate >40g as not immediately helpful, takes 6 months long term use increases prostate cx risk
47
PDE5 inhibitors
tadalafil 5mg PO Daily for BPH usually monotherapy
48
pelvic volume residual
measure of urine left in bladder after voiding, if > 50ml then it's positive, increased risk of infection
49
urinary retention and prostate cancer risk
start dutasteride or finasteride 5-alpha reductase inhibitor
50
alpha 1 adrenergic blockers that reduce BP significantly
doxazosin or terazosin
51
what age do you prefer topical NSAIDs vs oral?
75 year or older
52
1st line in RA
DMARDs methotrexate***, hydroxychloroquine (least side effects) sulfasalazine (slow onset, DOC in pregnancy) leflunomide
53
2nd line in RA
combo DMARDs or biologics... etanercept, infliximab, abatacept or rituximab most common
54
If you have ________ you should avoid TNF inhibitors
HF makes you immune compromised as well
55
TNF inhibitor list (5)
etanercept (Enbrel) - SQ infliximab (Remicade) - IV adalimumab (Humira) - SQ certolizumab (Cimzia) - SQ golimumab (Simponi) - SC
56
Non-TNF inhibitors for RA
abatacept (Orencia) anakinra (kineret) rituximab (rituxan) sarilumab (Kevazara) tocilizumab (Actemra)
57
gout is diagnosed with urate level of _____
>6.8 mg/dl
58
hours within onset to use colchicine
within 26 hours of attack onset
59
cochicine gout dosing in attack
1.2mg PO immediately, then 0.6mg one hour later continue 0.6mg BID until flare subsides can be fatal if used with pgp inhibitors or CYP3A4 inhibitors
60
tx for acute gout
colchicine, steroids, NSAIDs
61
NSAIDs FDA approved for gout
naproxen, indomethacin, sulindac
62
when to do continuous gout prophylaxis
tophi on imaging study or visual 2 or more attacks in a year damage caused by gout on bones
63
1st and 2nd line for gout px
allopurinol 100-300mg daily febuxostat if intolerant or allopurinol doesn't work
64
lesinurad
add on to allopurinol or febuxostat if urate levels not at goal may increase CV events
65
probenecid
later line agent for gout kidney stone, CrCl <50, not a great agent for gout
66
pegloticase
discontinue all other gout therapies and start here if last line 8mg IV q2w premedicate with benadryl and steroids
67
allopurinol skin reaction risks
SJS/TEN HCTZ, black or asian, HLA-B 5801, highest risk during first few months

Geriatrics (1 decks)

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