00:00 So, let's talk about a few of these classes of drugs and things that may come up on your exams and stuff you want to avoid. 00:06 Antipsychotics in and of themselves associated with a higher risk of fall and fracture. 00:10 Also associated with a higher risk of mortality overall. 00:13 So, really should be avoided. 00:15 When they’re absolutely necessary, in cases of dementia with severe agitation, a shared decision-making should be practiced with the family. 00:23 Maybe it keeps the patient in the home as opposed to going to an assisted living facility, but at the same time it is associated with a higher risk of death. 00:32 Glyburide is associated with this long half-life and, therefore, higher rates of hypoglycemia. 00:38 It should be avoided among older adults because there are other options out there if you need a sulfonylurea. 00:44 Benzodiazepines, you know, higher risk of delirium, higher risk of falls. 00:48 Sedative drugs, essentially the same. 00:52 Anticholinergic drugs, anything that is anticholinergic properties is dangerous for older adults. 00:56 It can promote constipation. 00:58 If the vision is blurry due to macular degeneration or cataracts, it can make that worse. 01:02 And also, worst of all, I think causes orthostasis, which may lead to falls as well. 01:09 So, other medications that are kind of on the watch list, you may need to use them. 01:13 Just be careful with them. 01:15 Anticoagulants are underused overall for conditions such as atrial fibrillation. 01:19 If you think about the average risk of stroke in most older adults with atrial fibrillation is about 5% per year. 01:26 The risk of a major bleed as well, lower than that. 01:29 Therefore, the benefit-to-risk ratio is still positive. 01:33 Nonetheless, if patients are falling, you know, every week, that's going to be too much of a risk. 01:41 And therefore, that needs to be corrected before considering or continuing anticoagulant therapy. 01:45 I've mentioned the risk of NSAIDs with GI bleeding, renal impairment and possible cardiovascular risk. 01:52 And then antihypertensive drugs, the systolic blood pressure per JNC 8 guidelines may be allowed increase to 150 among older adults above age 60. 02:04 I generally will try to be a little bit more strict with my control. 02:08 But certainly above age 75 or 80, the BP can become a liability when it becomes too low, and too low might be like 110. 02:17 So, therefore, something to consider. 02:19 Patients may need a down titration of their antihypertensive drugs as they move into that category above 75 or 80 years. 02:28 Hopefully, that was a helpful introduction to the care of older adults. 02:32 Thanks very much for your attention.
The lecture Medications for Older Adults by Charles Vega, MD is from the course Geriatric Care.
Which of the following medications has a higher risk of hypoglycemia?
What is the preferred initial management of neuropsychiatric symptoms in an elderly patient with dementia?
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