Age Edits What’s THAT all about
Age EditsWhat’s THAT all about
Beers Criteria for Potentially Inappropriate Medication (PIM) Use in Older Adults
AKA Beer’s List
• Highlights drug related problems and adverse drug events (ADE’s)
American Geriatrics Society (AGS)
Consensus of a panel of experts
Medication related problems
% Preventable Adverse Drug Events
Primary Care27%
Other Settings31%
Long Term Care42%
3 Categories of Medications to Avoid
1. Potentially inappropriate2. Potentially inappropriate in certain
diseases that the meds could make worse
3. Use with caution in elderly
Problems Associated With Inappropriate Medication Use
Falls and Fractures
Delirium and mental disorders
GI bleeding or Ulcers
Common Drugs on Age EditsAntihistamines – 1st generation – hydroxyzine, cyproheptadine
Risk of confusion, dry mouth, constipation, tolerance
Benzodiazepines – alprazolam, diazepam
Cognitive impairment, delirium, falls and fractures, motor vehicle accidents
Megestrol Minimal effect on weight; risk of thrombotic events and death
Estrogens and progestins- Premarin
Carcinogenic potential (breast and endometrium); no cardioprotective or cognitive protection in elderly.
Muscle relaxants –cyclobenzaprine, carisoprodol
Sedation, fracture risk, anticholinergic; effectiveness at tolerated dosages is questionable
What’s the deal with Hydroxyzine?HCl - Atarax Pamoate -
VisterilUsed with opioid analgesics to increase the pain-killing abilityNauseaanxiolytic
Itching
Clinical will be combining these into one criteria
The hydroxyzine-cetirizine connection
• A metabolite of hydroxyzine– Good antihistamine– Not as sedating– No anxiolytic effects– No analgesic sparing
properties
Zyvox - Cetirizine
Hydroxyzine HCl
It’s ok to ask!• Is it Medically Necessary?
– This isn’t leading – there is really no other way to get this information.
So in the end age edits are:
• Designed to keep our most vulnerable members safe
• Prepared by experts in the care of the elderly
• Based on scientific evidence• Reassessed routinely as new drugs or
information becomes available.