Elders are more likely to have adverse drug e�ects (ADE).

We all must beware for them. Six percent of hospital admissions are for ADE.

Of patients with ADE 30% are over 75, 25% of elders who have to be admitted.

Blood thinners – Coumadin/Warfarin, Plavix/Clopidogrel, Eliquis, Aspirin

Alone or in combination with Non-Steroidal Anti-In�ammatorymeds (NSAIDs), Naprosyn, Motrin/Ibuprofen, Steroids (Prednisone) these lead to a higher risk of internal bleeding, or bleeding in the head if there is a head injury.

Antibiotics – Most common here is allergic reaction. This could be anything from anaphylaxis – acute shortness of breath and low blood pressure/shock to severe rash, kidney damage. Important to always have the allergy list for the doctors.

The other more common side e�ect for elders from antibiotics is antibiotic associated diarrhea or Clostridia (C Di�) diarrhea, which in elders can be life threatening.

The last serious e�ect is the over use of antibiotics for viral infections (only anti-virals treat some viral infections), so best to avoid for colds, unless there is asthma, or emphysema, is drug resistant bacteria – if antibiotics are overused, when a serious infection does hit, it is more likely to be a drug resistant bacteria and more di�cult to treat, such as methacillin resistant staph infections (MRSA). Elder women often have a few white blood cells in their urine, and if they are not looking sick, should not have that treated with antibiotics (more about that in another episode).

Diabetes – Metformin is least likely to result in hypoglycemia (low blood sugar) while Glyburide is more likely than other oral agents to result in low blood sugar. This being said, Insulin is most likely to result in

For more information please visit us at elderconsult.com -OR- call 650.357.8834

Toxic Medications

TIP SHEET

Most Common

Elders at Risk

low blood sugar. Particularly with very short acting, Lispro. Note: It is critical to make sure the elder will eat, before giving Lispro. If an elder is eating erratically, best to err on the side of high glucose.

For elders, glucose should be between 100-200; not the 80-120 for adults.

Blood Pressure Medications – Often elders are kept on the same medications for years. However, elders often also eat less and lose weight as they age. That can lead to the blood pressure decreasing.

Standing blood pressure is a better test. If the BP is OK, say 120/70 standing, but may drop to 90/60 standing. That can increase the risk for fainting and falls. The arm must be relaxed and a manual cu� is more reliable than an automatic cu�.

Liver, kidney, thyroid and blood counts should also be tested at least yearly, they can be a�ected by blood pressure meds.

Antipsychotics – Seroquel, Zyprexa, Risperdal, most common, all have a 2% increased stroke risk and a 1% increased sudden death risk. Haldol has even worse e�ects and should not be used chronically. These medications should only be used for serious behaviors of delusions, paranoia, �xed thoughts that lead to distress in the elder, or aggression to others. These medications should be used only after removing other medications that can lead to aggression and treating pain. More on medications here.

Sleeping Pills, Anti-Anxiety Pills – Ativan, Xanax, Klonopin

Elders and women are three times more likely to get these meds for anxiety or poor sleep. They should only be used, if at all, for 10 days or less, but 1/3 of those prescribed these meds get long term prescriptions. The are quickly addictive and withdrawal can lead to more confusion, anxiety, agitation, and poor sleep. They also can lead to falls, confusion, accidents and in our practice, we do not prescribe these medications.

Narcotics – These medications should not be used regularly in elders. They can increase sedation, and thereby falls, constipation, nausea. They can be addictive, so should not be given to an elder who might just take unlimited amounts. However, for serious pain, such as fractures, or severe arthritis, they may be the only medications that relieve the pain.

NSAIDs increase risk of ulcers, bleeds and kidney damage, heart attacks and strokes.

Dementia Cures – There are not any supplements, pills to cure dementia.

Anticholinergic Medications – Tylenol PM, Atarax, Unisom, bladder pills, all decrease choline (the molecule the nerve cells use to communicate) and result in more confusion and aggression, as well as constipation, dry mouth and urinary problems. Click here for a more complete list.

Alcohol – Not a medication, but causes problems with many medications, from increased bleeding to higher blood pressure, poor sleep, confusion. Best to avoid as one ages.

Bring all your medications to the doctor. Work to minimize medications. Stay active, eat a Mediterranean diet.

Elders are more likely to have adverse drug e�ects (ADE).

We all must beware for them. Six percent of hospital admissions are for ADE.

Of patients with ADE 30% are over 75, 25% of elders who have to be admitted.

Blood thinners – Coumadin/Warfarin, Plavix/Clopidogrel, Eliquis, Aspirin

Alone or in combination with Non-Steroidal Anti-In�ammatorymeds (NSAIDs), Naprosyn, Motrin/Ibuprofen, Steroids (Prednisone) these lead to a higher risk of internal bleeding, or bleeding in the head if there is a head injury.

Antibiotics – Most common here is allergic reaction. This could be anything from anaphylaxis – acute shortness of breath and low blood pressure/shock to severe rash, kidney damage. Important to always have the allergy list for the doctors.

The other more common side e�ect for elders from antibiotics is antibiotic associated diarrhea or Clostridia (C Di�) diarrhea, which in elders can be life threatening.

The last serious e�ect is the over use of antibiotics for viral infections (only anti-virals treat some viral infections), so best to avoid for colds, unless there is asthma, or emphysema, is drug resistant bacteria – if antibiotics are overused, when a serious infection does hit, it is more likely to be a drug resistant bacteria and more di�cult to treat, such as methacillin resistant staph infections (MRSA). Elder women often have a few white blood cells in their urine, and if they are not looking sick, should not have that treated with antibiotics (more about that in another episode).

Diabetes – Metformin is least likely to result in hypoglycemia (low blood sugar) while Glyburide is more likely than other oral agents to result in low blood sugar. This being said, Insulin is most likely to result in

For more information please visit us at elderconsult.com -OR- call 650.357.8834

low blood sugar. Particularly with very short acting, Lispro. Note: It is critical to make sure the elder will eat, before giving Lispro. If an elder is eating erratically, best to err on the side of high glucose.

For elders, glucose should be between 100-200; not the 80-120 for adults.

Blood Pressure Medications – Often elders are kept on the same medications for years. However, elders often also eat less and lose weight as they age. That can lead to the blood pressure decreasing.

Standing blood pressure is a better test. If the BP is OK, say 120/70 standing, but may drop to 90/60 standing. That can increase the risk for fainting and falls. The arm must be relaxed and a manual cu� is more reliable than an automatic cu�.

Liver, kidney, thyroid and blood counts should also be tested at least yearly, they can be a�ected by blood pressure meds.

Antipsychotics – Seroquel, Zyprexa, Risperdal, most common, all have a 2% increased stroke risk and a 1% increased sudden death risk. Haldol has even worse e�ects and should not be used chronically. These medications should only be used for serious behaviors of delusions, paranoia, �xed thoughts that lead to distress in the elder, or aggression to others. These medications should be used only after removing other medications that can lead to aggression and treating pain. More on medications here.

Sleeping Pills, Anti-Anxiety Pills – Ativan, Xanax, Klonopin

Elders and women are three times more likely to get these meds for anxiety or poor sleep. They should only be used, if at all, for 10 days or less, but 1/3 of those prescribed these meds get long term prescriptions. The are quickly addictive and withdrawal can lead to more confusion, anxiety, agitation, and poor sleep. They also can lead to falls, confusion, accidents and in our practice, we do not prescribe these medications.

Narcotics – These medications should not be used regularly in elders. They can increase sedation, and thereby falls, constipation, nausea. They can be addictive, so should not be given to an elder who might just take unlimited amounts. However, for serious pain, such as fractures, or severe arthritis, they may be the only medications that relieve the pain.

TIP SHEET

NSAIDs increase risk of ulcers, bleeds and kidney damage, heart attacks and strokes.

Dementia Cures – There are not any supplements, pills to cure dementia.

Anticholinergic Medications – Tylenol PM, Atarax, Unisom, bladder pills, all decrease choline (the molecule the nerve cells use to communicate) and result in more confusion and aggression, as well as constipation, dry mouth and urinary problems. Click here for a more complete list.

Alcohol – Not a medication, but causes problems with many medications, from increased bleeding to higher blood pressure, poor sleep, confusion. Best to avoid as one ages.

Bring all your medications to the doctor. Work to minimize medications. Stay active, eat a Mediterranean diet.

Elders are more likely to have adverse drug e�ects (ADE).

We all must beware for them. Six percent of hospital admissions are for ADE.

Of patients with ADE 30% are over 75, 25% of elders who have to be admitted.

Blood thinners – Coumadin/Warfarin, Plavix/Clopidogrel, Eliquis, Aspirin

Alone or in combination with Non-Steroidal Anti-In�ammatorymeds (NSAIDs), Naprosyn, Motrin/Ibuprofen, Steroids (Prednisone) these lead to a higher risk of internal bleeding, or bleeding in the head if there is a head injury.

Antibiotics – Most common here is allergic reaction. This could be anything from anaphylaxis – acute shortness of breath and low blood pressure/shock to severe rash, kidney damage. Important to always have the allergy list for the doctors.

The other more common side e�ect for elders from antibiotics is antibiotic associated diarrhea or Clostridia (C Di�) diarrhea, which in elders can be life threatening.

The last serious e�ect is the over use of antibiotics for viral infections (only anti-virals treat some viral infections), so best to avoid for colds, unless there is asthma, or emphysema, is drug resistant bacteria – if antibiotics are overused, when a serious infection does hit, it is more likely to be a drug resistant bacteria and more di�cult to treat, such as methacillin resistant staph infections (MRSA). Elder women often have a few white blood cells in their urine, and if they are not looking sick, should not have that treated with antibiotics (more about that in another episode).

Diabetes – Metformin is least likely to result in hypoglycemia (low blood sugar) while Glyburide is more likely than other oral agents to result in low blood sugar. This being said, Insulin is most likely to result in

low blood sugar. Particularly with very short acting, Lispro. Note: It is critical to make sure the elder will eat, before giving Lispro. If an elder is eating erratically, best to err on the side of high glucose.

For elders, glucose should be between 100-200; not the 80-120 for adults.

Blood Pressure Medications – Often elders are kept on the same medications for years. However, elders often also eat less and lose weight as they age. That can lead to the blood pressure decreasing.

Standing blood pressure is a better test. If the BP is OK, say 120/70 standing, but may drop to 90/60 standing. That can increase the risk for fainting and falls. The arm must be relaxed and a manual cu� is more reliable than an automatic cu�.

Liver, kidney, thyroid and blood counts should also be tested at least yearly, they can be a�ected by blood pressure meds.

Antipsychotics – Seroquel, Zyprexa, Risperdal, most common, all have a 2% increased stroke risk and a 1% increased sudden death risk. Haldol has even worse e�ects and should not be used chronically. These medications should only be used for serious behaviors of delusions, paranoia, �xed thoughts that lead to distress in the elder, or aggression to others. These medications should be used only after removing other medications that can lead to aggression and treating pain. More on medications here.

Sleeping Pills, Anti-Anxiety Pills – Ativan, Xanax, Klonopin

Elders and women are three times more likely to get these meds for anxiety or poor sleep. They should only be used, if at all, for 10 days or less, but 1/3 of those prescribed these meds get long term prescriptions. The are quickly addictive and withdrawal can lead to more confusion, anxiety, agitation, and poor sleep. They also can lead to falls, confusion, accidents and in our practice, we do not prescribe these medications.

Narcotics – These medications should not be used regularly in elders. They can increase sedation, and thereby falls, constipation, nausea. They can be addictive, so should not be given to an elder who might just take unlimited amounts. However, for serious pain, such as fractures, or severe arthritis, they may be the only medications that relieve the pain.

Sponsored by ElderConsult Geriatric Medicine

For more information please visit us at elderconsult.com -OR- call 650.357.8834

NSAIDs increase risk of ulcers, bleeds and kidney damage, heart attacks and strokes.

Dementia Cures – There are not any supplements, pills to cure dementia.

Anticholinergic Medications – Tylenol PM, Atarax, Unisom, bladder pills, all decrease choline (the molecule the nerve cells use to communicate) and result in more confusion and aggression, as well as constipation, dry mouth and urinary problems. Click here for a more complete list.

Alcohol – Not a medication, but causes problems with many medications, from increased bleeding to higher blood pressure, poor sleep, confusion. Best to avoid as one ages.

Bring all your medications to the doctor. Work to minimize medications. Stay active, eat a Mediterranean diet.

TIP SHEET