2023 AGS Beers Criteria Flashcards

A selection of vocabulary flashcards detailing potentially inappropriate medications for older adults based on the 2023 AGS Beers Criteria.

First-generation Antihistamines (e.g., Diphenhydramine, Promethazine)

Highly anticholinergic drugs recommended to be avoided in older adults due to reduced clearance with age and risks of confusion, dry mouth, constipation, falls, delirium, and dementia.

Nitrofurantoin

An anti-infective that should be avoided in individuals with $CrCl < 30\,mL/min$ or for long-term suppression due to potential pulmonary toxicity, hepatoxicity, and peripheral neuropathy.

Aspirin for Primary Prevention

Recommendation to avoid initiating in older adults for the primary prevention of cardiovascular disease due to increased risk of major bleeding and lack of net benefit.

Warfarin (Initial Therapy)

Avoid starting as initial therapy for nonvalvular atrial fibrillation or VTE unless alternatives (DOACs) are contraindicated, as it carries higher risks of major bleeding, especially intracranial hemorrhage.

Rivaroxaban

A DOAC recommended to be avoided for long-term treatment of atrial fibrillation or VTE in favor of safer alternatives (like apixaban) due to higher risks of major and GI bleeding in older adults.

Non-selective Peripheral Alpha-1 Blockers (e.g., Doxazosin, Prazosin)

Antihypertensive agents to be avoided due to a high risk of orthostatic hypotension and associated harms in older adults.

Central Alpha-agonists (e.g., Clonidine)

Drugs to be avoided as routine or first-line treatment for hypertension due to high risk of adverse CNS effects, bradycardia, and orthostatic hypotension.

Nifedipine (Immediate Release)

Calcium channel blocker to be avoided because of the potential for hypotension and risk of precipitating myocardial ischemia.

Amiodarone

An antiarrhythmic to be avoided as first-line therapy for atrial fibrillation due to greater toxicities, unless the patient has heart failure or substantial left ventricular hypertrophy.

Dronedarone

Avoid in individuals with permanent atrial fibrillation or severe/recently decompensated heart failure due to worse outcomes.

Digoxin

Should be avoided as first-line therapy for atrial fibrillation or heart failure; if used, dosages should not exceed $0.125\,mg/day$ due to toxicity risks associated with decreased renal clearance.

Antidepressants with Strong Anticholinergic Activity (e.g., Amitriptyline, Paroxetine)

Highly anticholinergic and sedating drugs that cause orthostatic hypotension; generally recommended to be avoided in older adults.

Antipsychotics (Typical and Atypical)

Associated with an increased risk of stroke and greater rate of cognitive decline and mortality in persons with dementia; to be avoided except for specific FDA-approved indications or failed nonpharmacologic options.

Benzodiazepines

Drugs (e.g., Alprazolam, Diazepam) that increase sensitivity and risk of cognitive impairment, delirium, falls, fractures, and motor vehicle crashes in older adults; recommended to be avoided.

Nonbenzodiazepine Receptor Agonist Hypnotics ('Z-drugs')

Medications (e.g., Eszopiclone, Zolpidem) that should be avoided as they have adverse events similar to benzodiazepines, such as delirium, falls, and fractures.

Insulin, Sliding Scale

Insulin regimens containing only short- or rapid-acting insulin without basal insulin dosage; avoided due to high risk of hypoglycemia without improvement in hyperglycemia management.

Sulfonylureas (Long-acting)

Drugs like Glyburide (Glibenclamide) and Glimepiride that should be avoided due to higher risk of prolonged hypoglycemia, cardiovascular events, and all-cause mortality.

Proton-pump Inhibitors (PPIs)

Avoid scheduled use for $> 8$ weeks unless the patient is at high risk, due to associated risks of C. difficile infection, bone loss, fractures, and pneumonia.

Metoclopramide

Avoided unless for gastroparesis ($< 12$ weeks) due to potential for extrapyramidal effects, including tardive dyskinesia.

Desmopressin

A genitourinary medication to be avoided for nocturia or nocturnal polyuria because of the high risk of hyponatremia.

Non-COX-2-selective oral NSAIDs

Avoid chronic use (e.g., Ibuprofen, Naproxen) in older adults due to increased risk of GI bleeding, peptic ulcer disease, kidney injury, and increased blood pressure.

Indomethacin and Ketorolac

Specific NSAIDs to avoid; Indomethacin has the most adverse effects (CNS including), and Ketorolac increases the risk of GI bleeding and acute kidney injury.

Meperidine

An oral analgesic to be avoided due to lack of effectiveness at common doses and higher risk of neurotoxicity, including delirium.

Skeletal Muscle Relaxants (e.g., Cyclobenzaprine)

Avoided as they are poorly tolerated by older adults due to anticholinergic effects, sedation, and increased fracture risk.