Geriatric Pharm

Class

Associated Risks

General
Recommendations

BEERS

STOPP/START

Benzos
Short- Alprazolam,
Lorazepam,
Estazolam,
Temazepam

-Excessive sedation
-Daytime drowsiness
-Cognitive
impairment
-Disinhibition
-Weakness
-Falls

Avoid long acting

-Avoid all for

management of
insomnia, agitation
or delirium

-Avoid chronic use

when possible

-Similar to benzos

-recommended
dose for drugs
containing zolpidem
d/t risk of nextmorning impairment
-dose for women in
1/2
-Elderly more
sensitive to SEs

Avoid chronic use

>90 d

Long-Clonazepam,
Diazepam,
Chlordiazepoxide,
Flurazepam
Non-Benzo Hypnotics
Lunesta, Zolpidem,
Zaleplon

Anticholinergics
TCAs

Anticholinergics
Antihistamines

-Dry mouth
-Blurred vision
-Urinary retention
-Constipation
-Confusion/ delirium
-Cardiac arrhythmia
-Falls
See above

Neuropathic pain:
nortriptyline,
desipramine- less
anticholinergic

-Avoid all TCAs in

pts w/ dementia,
prolonged QT,
constipation or
urinary retention

-Gaba or duloxetine
-Elderly more
sensitive to SEs

Avoid
diphenhydramine for
sleep
-use non-sedating:
Loaratadine,
Fexofenadine,

Avoid
diphenhydramine for
sleep
-use non-sedating:
Loaratadine,
Fexofenadine,

Geriatric Pharm

Anticholinergics

Ceftirizine
-review regularly
-Avoid use altogether

Ceftirizine
-review regularly

BEERS

STOPP/START

See above

-Poorly tolerated
-Questionable
efficacy

Class

Associated Risks

General
Recommendations

Anticholinergics

See above

-Avoid in pts w/
dementia, XR and
newer agents better
tolerated
-try non-drug tx 1st

-Avoid in pts w/
dementia, XR and
newer agents better
tolerated
-try non-drug tx 1st

Antipsychs

-Confusion
-HoTN
-Falls
-Extrapyramidal SEs

-Avoid in pts with hx

of Parkinsons

Narcotics

-Sedation

-Avoid use for

dementia-related
behavior unless
threat to self or
others
-BBW- risk death
Avoid Demerol- toxic

Muscle relaxantsFlexaril, Soma,

Methocarbamol

Urinary
Antispasmodics
Old- Oxybutin
(crosses BBB),
Tolterodine
New-Tros[ium,
Darfenacin (highly
M3 selective),
Solidenacin(highly
M3 selective)

-Same as BEERS

Geriatric Pharm
-Respiratory
depression
-Cognitive
impairment
-Constipation
-Falls

NSAIDS

risk GI bleed &

renal toxicity
-Renal dysfxn w/ ACEI
-BBWCardiovascular risk

-Considered rarelt
and w/ extreme
caution
-If mod-severe pain
or QOL d/t pain
opiod
-Acetaminophen
should be initial
choice for tx of
persistent pain

Digoxin
Used for
symptomatic
improvement in HF,
rate control in afib
Warfarin
Numerous drug
interactions

-N/V
-Visual disturbances
-Palpitations
-Bradycardia
-Death

-Renally
eliminatedaccumul
ation & toxicity
Therapeutic rangs0.5-2.0 ng/mL
-Age >65 risk for
warfarin-related
bleeding
Other RF:
->75 YO
-Variable dietary

metabolite
accumulates in pts
w/ renal fxn
Preferred: Lortab,
Oxy, Morphine,
hydromorphone
USE CAUTION W/
DURAGESIC
-lowest dose for
shortest time
-GI PPX w/ PPI
-Monitor for adverse
effects
-Avoid Indomethaciner risk GI bleed,
CNS SEs
-Avoid Toradol- er GI
bleed

-Add laxative

-Doses >0.125
mg/day not
recommended

-Doses >0.125
mg/day not
recommended

-Same as BEERS

Geriatric Pharm
intakepoor anticoag
control
-Comorbids
- fxnl capacity