Geriatrics pharmacology

Beers list, STOPP/START criteria, terminology, PT implications

Benadryl

antihistamine

visatril

antihistamine

Phenergan

antihistamine and antiemetic

SE of antihistamines

anticholinergic effects

Nitrofurantoin / Macrobid

antibiotics

SE of antibiotics

peripheral neuropathy, liver disease, pulmonary fibrosis

digoxin / lanoxin

Antiarrhythmic

amiodarone / pacerone / cordarone

Antiarrhythmic

multag

Antiarrhythmic

norpace

Antiarrhythmic

SE of Antiarrhythmic

increased risk of toxicity, anticholinergic effects, fatal arrhythmias

lovenox

anticoagulant / antiplatelet

eloquis

anticoagulant / antiplatelet

pradaxa

anticoagulant / antiplatelet

aspirin

anticoagulant / antiplatelet

SE of anticoagulant / antiplatelet

increased risk of bleeding, severe hypotension

Methylprednisolone

Corticosteroids

Prednisone

Corticosteroids

Dexamethasone

Corticosteroids

SE of Corticosteroids

psychosis

humalog

fast acting insulin

SE of fast acting or sliding scale insulin

not very effective, unsafe hypoglycemia

Reglan

antiemetic

SE of antiemetic

anticholinergic effect, extrapyramidal signs

prilosec

proton pump inhibitor

nexium

proton pump inhibitor

protonix

proton pump inhibitor

SE of prolonged use of proton pump inhibitor

bone fx, c. diff, B12 deficiency

cyclobenzaprine / Flexeril

Muscle relaxants / antispasmodics

methocarbamol / Robaxin

Muscle relaxants / antispasmodics

metaxalone / Skelaxin

Muscle relaxants / antispasmodics

orphenadrine / norflex

Muscle relaxants / antispasmodics

SE of muscle relaxants / antispasmodics

anticholinergic effects, risk of fx

indomethacin / indocin

NSAID

ibuprofen / Advil / motrin

NSAID

Naproxen

NSAID

Meloxicam

NSAID

SE of NSAIDs

risk of GI bleed, heart failure, impaired renal function

pentazocines / talwin

opioids

meperidine / Demerol

opioids

SE of opioids

CNS dysfunction, OH with syncope, falls, substance misuse

Ok to use opioids with OA

acutely after joint replacement surgery or fracture

SSRI / Paxil

antidepressant

Tricyclics - amitriptyline / Elavil

antidepressant

Tricyclics - nortriptyline / Pamelor

antidepressant

SE of antidepressant

anticholinergic effect, somnolence, dizziness, hypotension, ataxia

Tegretol

anticonvulsant

Dilantin / phenytel

anticonvulsant

SE of anticonvulsant

CNS impact on gait, balance, and falls

Haldol

antipsychotic

Thorazine

antipsychotic

risperdal

antipsychotic

abilify

antipsychotic

clozapine

antipsychotic

SE of antipsychotic

anticholinergic effect, falls, fractures, increased mortality, limited effectiveness, risk of stroke, extrapyramidal signs

phenobarbital

sedative/hypnotic agents

phenobarbital other uses

antiseizure, substance withdrawal, kidney stones

ativan

sedative/hypnotic agents

xanax

sedative/hypnotic agents

clonazepam

sedative/hypnotic agents

diazepam / valium

sedative/hypnotic agents

lunesta

sedative/hypnotic agents

ambien

sedative/hypnotic agents

sonata

sedative/hypnotic agents

SE of sedative/hypnotic agents

CNS implications, fx, falls

pharmacokinetics

what the body does to drugs

pharmacodynamics

what drugs do to the body

therapeutic index

ratio of smallest does to have an impact to largest dose with producing a negative effect

wider TI

safer

narrow TI

inc risk of overdose/less sfae

Half-life

how long it takes for half of drug to be excreted

short half life

safer

long half life

increased risk of build-up/toxicity

agonist

activates receptors

anatgonist

blocks receptors

agonist/antiagonist

blocks some receptors and activates others

anticholinergic effects - CNS

AMS, confusion, drowsiness, delirium, nervousness, dizziness, memory changes

anticholinergic effects - PNS

bowel and bladder, visual changes, tachycardia

extrapyramidal sugsn

tardive dyskinesia, tremor, stiffness spasm, parkinsonism

tardive dyskinesia

uncontrolled abnormal repetitive muscle movement