Makindo Medical Notes"One small step for man, one large step for Makindo" |
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Related Subjects: |Beta Antagonists/Blockers |Calcium Channel Blockers |Corticosteroids |Nitrates |Diuretics |Non steroidal anti inflammatory drugs (NSAIDs)
| Drug Class & Examples | Prescribing Concerns |
|---|---|
| πΌ First-generation (sedating) antihistamines
Diphenhydramine, Chlorpheniramine, Promethazine, Cyproheptadine, Clemastine, Hydroxyzine, Doxylamine |
Sedating and strongly anticholinergic β β delirium, falls, urinary retention, dry mouth, constipation.
Note: Diphenhydramine may be appropriate in severe allergic reactions. |
| π Antispasmodics
Dicyclomine, Hyoscyamine, Propantheline, Oxybutynin (IR), Scopolamine, Belladonna alkaloids, Clidinium |
Strong anticholinergic properties β delirium, urinary retention, constipation.
Note: Hyoscyamine, scopolamine, and belladonna may be appropriate in palliative care (secretions). |
| π Tricyclic Antidepressants (TCAs)
Amitriptyline, Doxepin, Imipramine, Nortriptyline |
Avoid in elderly β sedating, strong anticholinergic, cause delirium, falls, constipation, orthostatic hypotension. |
| π§ Anticholinergic Anti-Parkinson Agents
Benztropine, Trihexyphenidyl |
Avoid β sedation, anticholinergic toxicity. Better alternatives exist for Parkinsonβs disease and EPS prevention. |
| πͺ Muscle Relaxants
Cyclobenzaprine, Methocarbamol, Carisoprodol, Metaxalone |
Limited benefit in elderly. Cause sedation, delirium, and β falls risk. |
| π΄ Benzodiazepines
Alprazolam, Lorazepam, Diazepam, Chlordiazepoxide, Clorazepate |
Avoid for delirium, sleep disorders, agitation. β risk of sedation and falls.
Note: May be appropriate for alcohol/benzo withdrawal. |
| π Non-benzodiazepine Hypnotics
Zolpidem |
Similar to benzodiazepines: β sedation, delirium, falls, fractures. Avoid in elderly. |
| π§© Antipsychotic Agents (Atypical & Conventional)
Haloperidol, Thioridazine, Chlorpromazine, Olanzapine, Quetiapine, Risperidone |
β Risk of stroke & death in elderly with dementia. Use only if non-drug measures fail and patient is at risk to self/others. |
| β¬οΈ Alpha-1 Blockers
Doxazosin, Prazosin, Terazosin |
Avoid as antihypertensives β high risk of orthostatic hypotension. Better agents available. |
| π©Ί CNS-acting Alpha Agonists
Clonidine, Methyldopa |
Associated with bradycardia, hypotension, sedation, delirium, depression. Avoid methyldopa; use clonidine cautiously. |
| β€οΈ Cardiac Glycosides
Digoxin (>0.125 mg/day) |
Higher doses β toxicity risk in elderly due to reduced renal clearance. No additional benefit at high doses. |
| π Antiarrhythmic Drugs
Amiodarone, Flecainide, Procainamide, Sotalol, Quinidine, Disopyramide |
Rate control often safer than rhythm control in elderly. Amiodarone β thyroid/lung toxicity, QT prolongation. Disopyramide β HF, anticholinergic. |
| π Non-COX Selective NSAIDs
Aspirin (>325 mg/day), Ibuprofen, Naproxen, Piroxicam, Indomethacin |
β GI bleeding, renal impairment, and HF exacerbation risk. If unavoidable, add PPI for gastroprotection. |
| π¬ Long-acting Sulfonylureas
Chlorpropamide, Glyburide |
β Risk of prolonged hypoglycaemia. Avoid in elderly. |
| π§ͺ Urinary Anti-infective Agent
Nitrofurantoin |
Avoid if CrCl <60 ml/min β ineffective & β neuropathy, hepatotoxicity risk. |