Beers Criteria Guided Questions for Spec Pops

Please read the Intent of Criteria section on page 2

The intentions of the criteria are to: improve medication selection; educate clinicians and patients; reduce adverse drug
events; and serve as a tool for evaluating quality of care, cost, and patterns of drug use of older adults.

What are risks associated with use of the first-generation anti-histamines in older people?
Highly anticholinergic; clearance reduced with advanced age, and tolerance develops when used as hypnotic; risk
of confusion, dry mouth, constipation, and other anticholinergic effects or toxicity

Are first-generation anti-histamines ever appropriate in older adults according to the Beers Criteria?
Use of diphenhydramine in situations such as acute treatment of severe allergic reaction may be appropriate

Why is doxazosin not recommended in older adults?

High risk of orthostatic hypotension; not recommended as routine treatment for hypertension; alternative agents
have superior riskbenefit profile

What is the recommended maximum dose of digoxin per the Beers Criteria?
If used for atrial fibrillation or heart failure, avoid dosages >0.125 mg/day
a fib is considered warranting a high dose

Why are tricyclic anti-depressants (TCAs--listed as Anti-depressants on Table 2 in the Beers Criteria
tablenote that every medication under this heading is a TCA) put on the Beers Criteria list?
Highly anticholinergic, sedating, and cause orthostatic hypotension; safety profile of low dose doxepin (6 mg/d)
comparable with that of placebo

The Beers Criteria state that anti-psychotics should be avoided in older adults with behavior problems in
dementia except for 2 situations. What are these 2 situations?
Increased risk of cerebrovascular accident (stroke) and greater rate of cognitive decline and mortality in persons
with dementia.

Avoid antipsychotics for behavioral problems of dementia or delirium unless nonpharmacological options (e.g.,
behavioral interventions) have failed or are not possible and the older adult is threatening substantial harm to self
or others.

Avoid, except for schizophrenia, bipolar disorder, or short-term use as antiemetic during chemotherapy
ask for clarification because I count 5 situations listed above.

Why are benzodiazepines placed on the Beers Criteria?

Older adults have increased sensitivity to benzodiazepines and decreased metabolism of long-acting agents; in
general, all benzodiazepines increase risk of cognitive impairment, delirium, falls, fractures, and motor vehicle
crashes in older adults
long acting benzos: May be appropriate for seizure disorders, rapid eye movement sleep disorders, benzodiazepine
withdrawal, ethanol withdrawal, severe generalized anxiety disorder, and periprocedural anesthesia

What does the Beers Criteria state regarding the use of aspirin for cardiovascular protection in older
adults? (see table 4)
Lack of evidence of benefit versus risk in adults aged 80 Use with caution in adults aged 80
this is a "strong reccomendation" regardless of evidence quality.

What is the number of CNS-active medications that the Beers Criteria considers to be an issue for falls?
(see table 5).
Avoid total of 3 CNS-active drugsa; minimize number of CNSactive drugs