The special physical characteristics of the elderly make us need to be wary of which drugs need to be avoided?
1. Anticholinergic drugs (excluding TCA)
Characteristics of drug use in the elderly: The first-generation antihistamines have high anticholinergic ability; with age, the clearance rate decreases, and when hypnotics are used, the tolerance is enhanced; there is a greater risk of confusion, dry mouth, Constipation and other anticholinergic effects and toxicity should be avoided.
Representative drugs: carbiumamine, chlorpheniramine, clemastine, cyproheptadine, bromophenamine, dextropheniramine, diphenhydramine (oral), doxylamine, hydroxyzine hydrochloride, promethazine , triprolidine.
2. Anti-Parkinson’s disease drugs (benzophenone, trihexyphenidate)
Characteristics of drug use in the elderly: Not recommended for the prevention of antipsychotic drugs, can cause extrapyramidal symptoms, and is only available when treating Parkinson’s disease more effectively. Medication recommended: avoid.
3. Antispasmodic drugs
Characteristics of medication for the elderly: Highly anticholinergic. Medication recommended: avoid. Excluding short-term palliative care to reduce oral secretions.
Representative drugs: belladonna alkaloids, Klee (limmine), bicyclovirin, anisodamine, probensin, scopolamine.
4. Antithrombotic drugs (dipyridamole, ticlopidine)
Characteristics of medication in the elderly: may lead to orthostatic hypotension; intravenous pressure test can be used intravenously. Medication recommended: Avoid.
5. Anti-infective drugs (nitrofurantoin)
Characteristics of drug use in the elderly: possible lung toxicity; medication recommendation: long-term depression; patients with CrCl <60ml / min avoided.
6. Cardiovascular drugs
(1) Alpha1 blocker (doxazosin, prazosin, terazosin)
Characteristics of medication in the elderly: high risk of orthostatic hypotension; not recommended as a routine treatment for hypertension. Medication recommended: Avoid use as an antihypertensive drug.
(2) Alpha central agonist (clonidine, enalapril, guanfacine, methyl dopalyx)
Characteristics of medication in the elderly: high risk of adverse central nervous system effects; may cause bradycardia and orthostatic hypotension; not recommended as a routine treatment for hypertension.
(3) antiarrhythmic drugs
Characteristics of medication for the elderly: Avoid using antiarrhythmic drugs as first-line treatment for atrial fibrillation.
Representative drugs: amiodarone, dofetilide, ibutilide, procaine, aproparone, quinidine, sotalol.
Propiamine is an effective negative cardiotonic drug, which may induce heart failure in the elderly; strong anticholinergic; other antiarrhythmic drugs should be preferred.
Dronedarone: Avoid patients with persistent atrial fibrillation or heart failure.
Nifedipine: Potential hypotension, risk of myocardial ischemia, not recommended.
Spironolactone: In patients with heart failure, the risk of hyperkalemia is higher, especially when taking > 25 mg / d or taking non-steroidal anti-inflammatory drugs, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers Or potassium supplements, etc.
7. Central nervous system drugs
(1) Third-generation TCA (single use or combination): high anticholinergic, sedative, and cause orthostatic hypotension. Medication recommended: Avoid.
Representative drugs: amitriptyline, chlordiazepoxide-amitriptyline, clomipramine
(2) Antipsychotic drugs:
Mesodarazine: increases the risk of cerebrovascular accidents (stroke) and mortality in patients with Alzheimer’s disease.
Thioridazine: A high anticholinergic drug that increases the risk of QT interval, increases the risk of cerebrovascular accidents (stroke) and mortality in Alzheimer’s patients.
Characteristics of medication in the elderly: high body dependence, resistance to falling asleep, low dose and excess risk. Medication recommended: Avoid.
Representative drugs: barbitalobarbital, sec-butyl barbital, butabutine, tolbital, pentobarbital, phenobarbital, and barcobarbital.
Characteristics of drug use in the elderly: The elderly have increased sensitivity to benzodiazepines and slow metabolism of long-acting agents. It is generally believed that benzodiazepine increases the risk of cognitive impairment, paralysis, falls, fractures and motor vehicle accidents in the elderly.
Representative drugs: alprazolam, estazolam, lorazepam, oxazepam, temazepam triazolam.
8. Endocrine drugs
Representative drugs: androgen, dry powder thyroid hormone, estrogen, progesterone, growth hormone
Sulfonylureas: Older people have a longer half-life and can cause prolonged hypoglycemia.
9. Gastrointestinal drugs
Characteristics of drug use in the elderly: causes extrapyramidal side effects, such as delayed dyskinesia, and the risk of debilitating elderly people; it may increase the risk of gastrointestinal bleeding and ulceration in high-risk groups.
Representative drugs: metoclopramide, trimetamide, analgesic meperidine, non-COX selective non-steroidal anti-inflammatory drugs (oral).
10. Skeletal muscle relaxant
Characteristics of medication in the elderly: Most muscle relaxants are poorly tolerated in the elderly because of the side effects caused by anticholinergic effects such as sedation and fracture risk. Medication recommended: Avoid.
Representative drugs: isopropyl methicillin, chlorzoxazone, Cyclobenzaprine, Metaxalone, Mesobaramofen
As the saying goes: “Garbage is the treasure at the wrong place!” Similarly, if the drug is used properly, it is a life-saving medicine. If it is not used well, it is a murder weapon. The above drugs are special for the elderly, we need to be vigilant and careful to avoid using.