Makindo Medical Notes"One small step for man, one large step for Makindo" |
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Related Subjects: |Beta Antagonists/Blockers |Calcium Channel Blockers |Corticosteroids |Nitrates |Diuretics |Non steroidal anti inflammatory drugs (NSAIDs)
Class | Drug Examples | Prescribing Concerns |
---|---|---|
First-generation (sedating) antihistamines | Diphenhydramine, Chlorpheniramine, Promethazine, Cyproheptadine, Clemastine, Hydroxyzine, Doxylamine |
Sedating and strongly anticholinergic; increase risk of delirium, falls, urinary retention, dry mouth, and constipation.
Note: Diphenhydramine may be appropriate for acute treatment of severe allergic reactions. |
Antispasmodics | Dicyclomine, Hyoscyamine, Propantheline, Oxybutynin (immediate release), Scopolamine, Belladonna alkaloids, Clidinium |
Strong anticholinergic properties; increase risk of delirium, falls, urinary retention, dry mouth, and constipation.
Note: Hyoscyamine, scopolamine, and belladonna alkaloids may be appropriate for palliative care to dry secretions. |
Tricyclic Antidepressants (TCAs) | Amitriptyline, Doxepin, Imipramine, Nortriptyline | Avoid in elderly due to sedating and strong anticholinergic properties; promote delirium, falls, urinary retention, constipation, and orthostatic hypotension. |
Anticholinergic Anti-Parkinson Agents | Benztropine, Trihexyphenidyl | Avoid due to sedation and anticholinergic properties; better medications are available for Parkinson’s disease and for prevention of extrapyramidal symptoms from antipsychotic medications. |
Muscle Relaxants | Cyclobenzaprine, Methocarbamol, Carisoprodol, Metaxalone | Avoid in elderly due to sedation and anticholinergic effects; questionable effectiveness, increases risk of delirium, sedation, and falls. |
Benzodiazepines | Alprazolam, Lorazepam, Diazepam, Chlordiazepoxide, Clorazepate |
Avoid in elderly for delirium, sleep disorders, or agitation; increases sensitivity to side effects like sedation and falls.
Note: May be appropriate for alcohol or benzodiazepine withdrawal. |
Non-benzodiazepine Hypnotics | Zolpidem | Avoid due to sedation; increases risk of delirium, falls, and fractures in elderly, similar to benzodiazepines. |
Antipsychotic Agents (Atypical and Conventional) | Haloperidol, Thioridazine, Chlorpromazine, Olanzapine, Quetiapine, Risperidone | Avoid for behavioral problems in elderly due to increased risk of stroke and death, unless non-pharmacologic measures have failed and the patient is a risk to themselves or others. |
Alpha-1 Blockers | Doxazosin, Prazosin, Terazosin | Avoid use as antihypertensive due to high risk of orthostatic hypotension; better options are available. |
CNS-acting Alpha Agonist Hypotensive Agents | Clonidine, Methyldopa | Associated with bradycardia, orthostatic hypotension, sedation, delirium, and depression; avoid methyldopa and use clonidine with caution, not as a first-line antihypertensive. |
Cardiac Glycosides | Digoxin (> 0.125 mg daily) | Higher doses increase risk of toxicity without additional benefit; risk of toxicity is elevated in elderly due to reduced renal function. |
Antiarrhythmic Drugs | Amiodarone, Flecainide, Procainamide, Sotalol, Quinidine, Disopyramide | Risk-benefit favors rate control over rhythm control in older adults. Amiodarone associated with thyroid and pulmonary issues, QT prolongation; disopyramide may precipitate heart failure and has anticholinergic effects. |
Non-COX Selective NSAIDs | Aspirin (> 325 mg/day), Ibuprofen, Naproxen, Piroxicam, Indomethacin | Avoid chronic use unless no alternatives; consider a PPI to reduce GI bleeding risk; increases risk of reduced renal function and may exacerbate heart failure. |
Long-acting Sulfonylureas | Chlorpropamide, Glyburide | Avoid in elderly due to increased risk of prolonged hypoglycemia. |
Urinary Anti-infective Agent | Nitrofurantoin | Avoid in patients with creatinine clearance below 60 ml/min due to lack of therapeutic efficacy and increased risk of neuropathy and hepatotoxicity. |