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.