Pharmacology 1: Block 4 Inappropriate Drugs for Elderly

Aspirin for primary prevention of cardiovascular disease

Recommendation: Potentially inappropriate - avoid initiating in elderly patients for primary prevention

Antipsychotics

Recommendation: Potentially inappropriate - increase risk of CVA and worsen cognitive decline; avoid unless danger to self or others

Benzodiazepines

Recommendation: Potentially inappropriate - risk of cognitive effects and injury (falls); avoid

Estrogens

Recommendation: Potentially inappropriate - do not initiate systemic estrogen (vaginal cream/tablets acceptable); women who start HRT at age 60 or older have risks of blood clots and heart disease that outweigh benefits

Sulfonylureas

Recommendation: Potentially inappropriate - risk of hypoglycemia and higher risk of cardiovascular events than alternative agents; avoid

Muscle relaxants

Recommendation: Potentially inappropriate - anticholinergic effects; avoid

Rivaroxaban for treatment of nonvalvular afib or VTE

Recommendation: Potentially inappropriate - higher risk of bleeding in older adults than other DOACs; avoid for long-term treatment

Warfarin for treatment of nonvalvular afib or VTE

Recommendation: Potentially inappropriate - higher risk of bleeding in older adults than other DOACs; avoid for long-term treatmen

Drugs to avoid in Delirium

Recommendation: Avoid anticholinergics, antipsychotics, benzodiazepines, corticosteroids, H2 receptor antagonists (antihistamines), opioids (avoid except in situations of high benefit/risk)

Drugs to avoid in Dementia

Avoid anticholinergics, antipsychotics, benzodiazepines