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Minimizing Adverse Effects and Drug Interactions Sandra A. Jacobson, M.D. Research Associate Professor University of Arizona College of Medicine Phoenix

Poor prescription practices American Geriatrics Society 2015 Beers Criteria Update Expert Panel. American Geriatrics Society 2015 updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2015 Nov;63(11):2227-46.

Examples (used for insomnia): Long-acting benzodiazepines First-generation tricyclics Diphenhydramine (Benadryl) Poor prescription practices American Geriatrics Society 2015 Beers Criteria Update Expert Panel. American Geriatrics Society 2015 updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2015 Nov;63(11):2227-46.

Acquaint yourself with the Beers list of medications Examples (used for insomnia): Long-acting benzodiazepines First-generation tricyclics Diphenhydramine (Benadryl) Poor prescription practices Acquaint yourself with the Beers list of medications American Geriatrics Society 2015 Beers Criteria Update Expert Panel. American Geriatrics Society 2015 updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2015 Nov;63(11):2227-46.

Do one thing at a time Use only one drug if possible

Polypharmacy may occur: Do one thing at a time Use only one drug if possible Sometimes two drugs are indicated Polypharmacy may occur: When the initial diagnosis and target symptoms are not clear

Drugs started by a psychiatrist may never be stopped

Drugs started by a psychiatrist may never be stopped Specify: Treatment endpoint Time for follow-up

Start low and go slow

Start low and go slow Effective doses: One-half to one-third of the usual dose

Dividing the drug dosage Start low and go slow Effective doses: One-half to one-third of the usual dose Dividing the drug dosage Helpful where adverse effects are related to peak levels

Dividing the drug dosage Start low and go slow Effective doses: One-half to one-third of the usual dose Dividing the drug dosage Helpful where adverse effects are related to peak levels Adherence drops

Be very selective about PRN use

Be very selective about PRN use Long-term PRN use

Key Points Remember the Beers list of potentially inappropriate medications for elderly patients

Key Points Remember the Beers list of potentially inappropriate medications for elderly patients You should become acquainted with this and have a copy handy

Key Points Remember the Beers list of potentially inappropriate medications for elderly patients You should become acquainted with this and have a copy handy Remember to start low and go slow

Key Points Remember the Beers list of potentially inappropriate medications for elderly patients You should become acquainted with this and have a copy handy Remember to start low and go slow Effective doses may be one-half to one-third of the usual dose

Key Points Remember the Beers list of potentially inappropriate medications for elderly patients You should become acquainted with this and have a copy handy Remember to start low and go slow Effective doses may be one-half to one-third of the usual dose If a side effect is dose dependent, you can consider multiple daily doses This can decrease treatment compliance

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