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2. Minimizing Adverse Effects and Drug Interactions
Sandra A. Jacobson, M.D.
Research Associate Professor
University of Arizona College of Medicine Phoenix

3. Poor prescription practices
American Geriatrics Society 2015 Beers Criteria Update Expert Panel. American Geriatrics Society 2015 updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc Nov;63(11):

4. Examples (used for insomnia): Long-acting benzodiazepines
First-generation tricyclics
Diphenhydramine (Benadryl)
Poor prescription practices
American Geriatrics Society 2015 Beers Criteria Update Expert Panel. American Geriatrics Society 2015 updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc Nov;63(11):

5. Acquaint yourself with the Beers list of medications
Examples (used for insomnia):
Long-acting benzodiazepines
First-generation tricyclics
Diphenhydramine (Benadryl)
Poor prescription practices
Acquaint yourself with the Beers list of medications
American Geriatrics Society 2015 Beers Criteria Update Expert Panel. American Geriatrics Society 2015 updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc Nov;63(11):

6. Do one thing at a time
Use only one drug if possible

7. Polypharmacy may occur:
Do one thing at a time
Use only one drug if possible
Sometimes two drugs are indicated
Polypharmacy may occur:
When the initial diagnosis and target symptoms are not clear

8. Drugs started by a psychiatrist may never be stopped

9. Drugs started by a psychiatrist may never be stopped
Specify:
Treatment endpoint
Time for follow-up

10. Start low and go slow

11. Start low and go slow Effective doses:
One-half to one-third of the usual dose

12. Dividing the drug dosage
Start low and go slow
Effective doses:
One-half to one-third of the usual dose
Dividing the drug dosage
Helpful where adverse effects are related to peak levels

13. Dividing the drug dosage
Start low and go slow
Effective doses:
One-half to one-third of the usual dose
Dividing the drug dosage
Helpful where adverse effects are related to peak levels
Adherence drops

14. Be very selective about PRN use

15. Be very selective about PRN use
Long-term PRN use

16. Key Points
Remember the Beers list of potentially inappropriate medications for elderly patients

17. Key Points
Remember the Beers list of potentially inappropriate medications for elderly patients
You should become acquainted with this and have a copy handy

18. Key Points
Remember the Beers list of potentially inappropriate medications for elderly patients
You should become acquainted with this and have a copy handy
Remember to start low and go slow

19. Key Points
Remember the Beers list of potentially inappropriate medications for elderly patients
You should become acquainted with this and have a copy handy
Remember to start low and go slow
Effective doses may be one-half to one-third of the usual dose

20. Key Points
Remember the Beers list of potentially inappropriate medications for elderly patients
You should become acquainted with this and have a copy handy
Remember to start low and go slow
Effective doses may be one-half to one-third of the usual dose
If a side effect is dose dependent, you can consider multiple daily doses
This can decrease treatment compliance

21. Next Presentation: How Pharmacokinetic and Pharmacodynamic Changes in the Elderly Affect Prescribing