Deprescribing Flashcards
(34 cards)
T/F: All medications on the Beer’s list should be discontinued at age 65
FALSE
Just use as a “warning light” for clinical decision-making
What is clinical inertia?
Keeping a patient’s therapy consistent when it is working instead of making changes for optimization that may not be necessary
What classes of drugs are potentially inappropriate medications for older adults (PIMs)?
- Anticholinergics
- Benzodiazepines
- Antidepressants
- NSAIDs
What are anticholinergic side effects?
- Impaired vision (falls/accidents)
- Dry mouth (infection/malnutrition)
- GI problems (malnutrition/pain)
- CV problems (anxiety/disease worsening)
- Urinary issues (incontinence/infection)
- CNS problems (dysfunction/impaired ADL)
What classes of drugs are anticholinergic?
- Muscle relaxants
- Antispasmodics
- TCAs
- Antihistamines
What is the anticholinergic activity level of amitriptyline?
25mg/17.6
What is the anticholinergic activity level of paroxetine?
20mg/5.4
What is the anticholinergic activity level of atropine?
0.4mg/20.25
What is the anticholinergic activity level of oxybutinin?
10mg/5.5
What is the anticholinergic activity level of tolterodine?
2mg/9.75
What indications make benzodiazepines appropriate for older adults?
- Seizures
- REM sleep behaviors
- Benzodiazepine withdrawal
- Ethanol withdrawal
- Severe anxiety
- Anesthesia for procedure
What is associated with a dose of >3mg of diazepam equivalents in older adults?
> 50% increase in hip fracture risk
T/F: SSRIs should be used instead of benzos for anxiety since they do not carry the same fall risk
FALSE: data shows us a similar increase in fall risk
What are some NSAID toxicities in older adults?
- GI effects (ulcers, PUD)
- CV disease
- Renal issues
NSAID GI toxicity is dose (dependent/independent)
Dependent
What can we use to prevent NSAID GI toxicity?
- Misoprostol (needs high dose)
- H2RA (doubled dose needed)
- PPIs (gold standard)
COX-2 selective agents should be used for high-risk patients
T/F: All NSAIDs increase risk of acute MI, INCLUDING celecoxib and naproxen
TRUE
When should you especially avoid NSAIDs in older adults?
History of MI/stroke
What do NSAIDs do to the kidneys?
- Reduction in renal blood flow
- Sodium/water retention
(Fluid overload, acute renal failure)
What are the domains of of deprescribing barriers?
- Individual/patient factors
- Sociocultural factors
- Personal and relational factors
- Organizational factors
What are the steps of deprescribing?
- Comprehensive med history
- Identify inappropriate meds
- Determine if it/they can be deprescribed
- Plan and initiate deprescribing
- Monitor, support, document
What would make a med discontinuable?
- No valid indication
- Part of a prescribing cascade
- Harm clearly outweighs potential benefit
- Preventative med unlikely to confer benefit (older patients)
- Impose unacceptable treatment burden
Patient wishes + Clinician opinion = ?
Shared healthcare decisions
What are drug-related risk factors of drug induced harm?
- Number of medications prescribed
- Use of potentially inappropriate or “high risk” drugs
- Past or current toxicity
