5. STOPP/START

Define the STOPP/START Criteria

STOPP/START Criteria - Negatives

How does it differ from Beers criteria

STOPP - Loop Diuretics

STOPP - Centrally acting antihypertensives

STOPP

• Statins

• Long term Antipsychotics

STOPP

• Anti platelet agents, Vitamin K antagonists, Direct thrombin inhibitors, or factor Xa inhibitors

• SSRIs in combo w Anti-platelets

STOPP

• Systemic estrogens or androgens

• SNRIs

STOPP

• Antipsychotics with moderate-marked antimuscarinic/anticholinergic

• Antipsychotics prescribed for BPSD

STOPP

• SSRI w recent hyponatremia

• SSRI w current or recent bleeding

STOPP

• BZDs for 4 or more weeks

• BZDs for dementia

• BZD for insomnia for 2 or more weeks

STOPP

• Z-drugs

• Antipsychotics in those w PD

• Anticholinesterase inhibitors

STOPP

• Memantine

• Levodopa or Dopamine (Sinamet)

STOPP

• Anti-cholinesterase inhibitors

• PPI’s for uncomplicated PUD

STOPP

• Megestrol

• Long acting muscarinic antagonists

STOPP

• Systemic antimuscarinics

  • w dementia or chronic cognitive impairment

  • narrow angle glaucoma

  • lower urinary tract symptoms

  • constipation

STOPP

• Antimuscarinic drugs w overactive bladder syndrome

• Duloxetine

STOPP

• SGLT2-i

• Systemic estrogens w out progesterone inpts w intact uterus

STOPP - Section K

• BZDs

• Antipsychotics

• Hypnotic Z-drugs

STOPP

• Paracetamol at what doses

START

• Antihypertensive

• IV

START

• Bisphosphonates and Vitamin D and Calcium

  • recall T-score

• Vitamin D

• Bone anti-resorptive or anabolic therapy

START

• Vitamin D Supplement

• Anti-resorptive treatment after d/c of…

• Anti-resorptive treatment after d/c of…

• Lidocaine patch

What vaccines to consider in geriatrics (>65, exception, shingrix vaccine)

• Flu - high dose preferred for better immune response, but if pt comes in for flu vaccine and High Dose not available - do not turn them away if they are ok with receiving a lower dose

• refer to highlighted notes for exam - but for COVID just know that it is annually recommended for geriatrics

Vaccine - Pneumococal vaccines

• PCV has a higher immune response than the PPSV

Define Shared Clinical Decision Making (SCDM)

• Exam Question - What is SCDM?

  • conversation with the physician and the patient

Define

• Polypharmacy

• De-escalation

• Deprescribing

Prescribing cascade

STOPP/START Criteria Recap

• what does it include

  • recall Beers criteria is only stop or switch/alternatives

• STOPP Criteria is based on what (2)

• Setbacks (3)