Beers Basics
This organization publishes and updates the Beers Criteria, a list of potentially inappropriate medications that are best avoided by older adults.
What is the AGS (American Geriatrics Society)?
This generation of antihistamines should be avoided due to their highly anticholinergic properties, increasing the risk of falls, delirium, and dementia.
What are first generation antihistamines?
If using an oral antihistamine, these second or third generation agents are preferred. Name two of the four agents preferred listed in the Beers Criteria.
What is loratadine, cetirizine, levocetirizine, and fexofenadine?
In patients with a history of urogenital infections, this diabetes medication class should be avoided.
What are SGLT2 inhibitors?
A 70 year old patient with diabetes is presenting to your clinic. They tell you that they are not on any diabetes medications and would like a lower cost oral option. This medication would be a recommended first line agent for this patient with hyperglycemia given their medication preferences.
What is metformin?
The Beers Criteria is intended to guide medication use in this population.
Who are adults aged 65 years and older?
This class of antidepressants should be avoided due to their strong anticholinergic activity and risk for orthostatic hypotension.
What are tricyclic antidepressants (TCAs)?
Among sulfonylureas, this short-acting sulfonylurea has a lower risk of prolonged hypoglycemia compared to long-acting sulfonylurea agents.
What is glipizide?
This DOAC should be avoided in patients with CrCl > 95 mL/min?
What is edoxaban?
A 75 year old patient presents to your retail pharmacy complaining of insomnia. This is recommended as the initial treatment for chronic insomnia in older adults.
What is cognitive behavioral therapy (CBT)?
True or False: The Beers Criteria is intended to replace shared clinical decision-making and clinical judgement.
What is false?
This class of pain medications should be avoided due to their increased risk of GI bleeding/peptic ulcer disease, as well as their potential to increase blood pressure and induce kidney injury.
What are non-steroidal anti-inflammatory drugs (NSAIDs)?
This medication class is the preferred anticoagulation choice for most patients for the treatment of nonvalvular atrial fibrillation or venous thromboembolism.
What are direct oral anticoagulants (DOACs)?
This commonly used antibiotic has an increased risk of hyperkalemia when used concurrently with an ACEi, ARB, or ARNI in the presence of renal dysfunction?
What is sulfamethoxazole-trimethoprim/Bactrim?
A doctor at your clinic asks you about a patient with atrial fibrillation who needs rate control. This medication class can be used as an appropriate rate control alternative to digoxin for most patients.
What are beta blockers?
This term is used by the Beers Criteria to describe medications that pose more harm than benefits in older adults.
What are potentially inappropriate medications (PIMS)?
This class of gastrointestinal medications should be avoided for scheduled use for >8 weeks due to its risk of C. difficile infection, pneumonia, GI malignancies, bone loss, and fractures.
What are proton-pump inhibitors (PPIs)?
These agents are recommended to be initiated as guideline-directed medical therapy (GDMT) for patients with heart failure with reduced ejection fraction.
What are ARNI/ACEi/ARBs, beta blockers, MRAs, and SGLT2 inhibitors?
This fluoroquinolone requires dose reductions when CrCl < 30 mL/min due to increased risk of tendon rupture and CNS effects such as seizures and confusion.
What is ciprofloxacin?
An 80 year old patient presents to your clinic. They are on digoxin 0.25 mg daily for heart failure. The recommended dose of digoxin should not exceed this when used for heart failure.
What is 0.125 mg?
The Beers Criteria is intended to be applied to older adults in all settings of care except for these two certain care settings.
What are hospice and end-of-life care settings?
Avoid initiating this commonly prescribed medication that can be found OTC for primary prevention of cardiovascular disease due to the risk of major bleeding that can increase with older age.
What is aspirin?
While benzodiazepines are best avoided in older adults, these 3 are the best options for short term use due to their shorter half-lives.
What are lorazepam, oxazepam, and temazepam (LOT)?
In patients with heart failure with reduced ejection fraction, these two blood pressure medications should be avoided due to their potential to promote fluid retention and/or exacerbate heart failure.
What are diltiazem and verapamil?
An 85 year old patient with a past medical history of depression is presenting with weight loss. This medication could be used as an appetite stimulant and be beneficial for their depression.
What is mirtazapine?