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Polypharmacy

Background, Goal and Objectives Polypharmacy PDF
Polypharmacy - weighing up the benefits and harms
Elderly people are at increased risk of drug related problems
Drugs associated with increased risk of adverse drug reactions in elderly people
Common drug interactions in elderly people
Recognising adverse drug reactions
Risk factors for drug related problems in elderly people
A really good recipe for DRP
Drug related harm; terms and definitions
Hospital admissions for adverse drug reactions
Commonly reported adverse drug reactions
References, Bibliography

Drugs associated with increased risk of adverse drug reactions in elderly people

Because of age related changes in drug handling described previously certain drugs are associated with increased risk of adverse drug reactions when given to elderly people.

If the potential benefits of these drugs for an individual patient appear to outweigh the risks of harm they should be used with caution; otherwise they should be avoided.

Some drugs associated with adverse drug reactions in the elderly
Drug or drug class Comments
All drugs Start low, go slow. Many drugs, e.g. oxybutynin, antipsychotics, TCAs, antihypertensives need much lower doses in elderly people.
benzodiazepines Those with a long half-life, such as diazepam, nitrazepam cause excessive and prolonged sedation. Temazepam is a better choice if necessary but all are best avoided.
cimetidine More drug interactions and a greater potential for confusion than ranitidine.
dextropropoxyphene Can cause confusion and excessive sedation in the elderly.
digoxin Use low doses initially. Extra vigilance required for those who need to be on higher doses.
indomethacin This NSAID has a high incidence of CNS effects and gastrotoxicity.
nefopam (Acupan) CNS effects and marked anticholinergic actions; avoid.
NSAIDs Use lowest dose necessary for the shortest period. Avoid long-term use of full dose, longer half-life drugs such as naproxen and piroxicam.
tricyclic antidepressants (TCAs) Doxepin and amitriptyline are very sedating and have strong anticholinergic actions. Not preferred as first choice for depression in the elderly.
thioridazine (Aldazine) Greater potential for CNS and extrapyramidal effects.

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