Medication and Falls: Difference between revisions
Scott Buxton (talk | contribs) No edit summary |
Scott Buxton (talk | contribs) No edit summary |
||
Line 13: | Line 13: | ||
|+ Psychotropic Drugs and Falls Risk<ref name="FallSafe">Darowski A. Dwight J. Reynolds J. Medicines and Falls in Hospital: Guidance Sheet [ONLINE] available from https://www.rcplondon.ac.uk/sites/default/files/documents/medicines-and-falls2.pdf date accessed 14/01/2015</ref> | |+ Psychotropic Drugs and Falls Risk<ref name="FallSafe">Darowski A. Dwight J. Reynolds J. Medicines and Falls in Hospital: Guidance Sheet [ONLINE] available from https://www.rcplondon.ac.uk/sites/default/files/documents/medicines-and-falls2.pdf date accessed 14/01/2015</ref> | ||
|- | |- | ||
| '''Medication Group''' | | '''Medication Group''' | ||
| '''Overall Risk Category''' | | '''Overall Risk Category''' | ||
| '''Commonly Used Medications''' | | '''Commonly Used Medications''' | ||
| '''Effects on Risk''' | | '''Effects on Risk''' | ||
|- | |- | ||
| Sedatives | | Sedatives | ||
| | | | ||
<u>'''''HIGH RISK'''''</u> | <u>'''''HIGH RISK'''''</u> | ||
Can cause falls alone | Can cause falls alone | ||
| | | | ||
Lorazepam, Temazepam, Nitrazepam | Lorazepam, Temazepam, Nitrazepam | ||
similar '''''-epam'''''suffix | similar '''''-epam'''''suffix | ||
Line 33: | Line 33: | ||
| Sedating Antidepressants | | Sedating Antidepressants | ||
| | | | ||
'''<u>''HIGH RISK''</u>''' | '''<u>''HIGH RISK''</u>''' | ||
Can cause falls alone | Can cause falls alone | ||
| Amitriptyline, Nortriptyline | | Amitriptyline, Nortriptyline | ||
| Orthostatic hypotension, drowsiness, slow reactions. '''DOUBLE THE RATE OF FALLS''' | | Orthostatic hypotension, drowsiness, slow reactions. '''DOUBLE THE RATE OF FALLS''' | ||
|- | |- | ||
| Monoamine Oxidase Inhibitors | | Monoamine Oxidase Inhibitors | ||
| | | | ||
'''<u>''HIGH RISK''</u>''' | '''<u>''HIGH RISK''</u>''' | ||
Can cause falls alone | Can cause falls alone | ||
| Phenelzine, Moclobemide | | Phenelzine, Moclobemide | ||
| Severe orthostatic hypotension | | Severe orthostatic hypotension | ||
|- | |- | ||
| For Psychosis Agitation | | For Psychosis Agitation | ||
| | | | ||
'''<u>''HIGH RISK''</u>''' | '''<u>''HIGH RISK''</u>''' | ||
Can cause falls alone | Can cause falls alone | ||
| Haloperidol, Chlorpromazine, Olanzapine | | Haloperidol, Chlorpromazine, Olanzapine | ||
| Orthostatic hypotension, slow reflexes, loss of balance | | Orthostatic hypotension, slow reflexes, loss of balance | ||
|- | |- | ||
| Selective Serotonin Reuptake Inhibitors (SSRI) and Serotonin and Noradrenaline Reuptake Inhibitor )SNRI) | | Selective Serotonin Reuptake Inhibitors (SSRI) and Serotonin and Noradrenaline Reuptake Inhibitor )SNRI) | ||
| | | | ||
'''<u>''MODERATE RISK''</u>''' | '''<u>''MODERATE RISK''</u>''' | ||
Can cause falls in combination | Can cause falls in combination | ||
| Fluoxetine, Sertaline, Paroxetine, Venlafaxine, Duloetine | | Fluoxetine, Sertaline, Paroxetine, Venlafaxine, Duloetine | ||
| Increased risk of falls with fractures, orthostatic hypotension, bradycardia, impaired sleep quality | | Increased risk of falls with fractures, orthostatic hypotension, bradycardia, impaired sleep quality | ||
|- | |- | ||
| Opiate Analegsics | | Opiate Analegsics | ||
| | | | ||
''<u>'''HIGH RISK'''</u>''<u></u> | ''<u>'''HIGH RISK'''</u>''<u></u> | ||
Can cause falls alone<br> | Can cause falls alone<br> | ||
| Codeine, Morphine, Tramadol | | Codeine, Morphine, Tramadol | ||
| Sedates, slows reactions, impairs balance, delirium | | Sedates, slows reactions, impairs balance, delirium | ||
|- | |- | ||
| Anti Epileptics | | Anti Epileptics | ||
| '''<u>''HIGH RISK''</u>''' | | '''<u>''HIGH RISK''</u>''' | ||
| Phenytoin, Carbamazepine, Phenobarbitone | | Phenytoin, Carbamazepine, Phenobarbitone | ||
| Cerebellar damage, ataxia, slowed reactions | | Cerebellar damage, ataxia, slowed reactions | ||
|- | |- | ||
| | | | ||
| '''<u>''MODERATE RISK''</u>''' | | '''<u>''MODERATE RISK''</u>''' | ||
| Sodium Valporate, Gabapentin | | Sodium Valporate, Gabapentin | ||
| Some association with falls risk | | Some association with falls risk | ||
|- | |- | ||
| Parkinson's Disease - Dopamine Agonists | | Parkinson's Disease - Dopamine Agonists | ||
| '''<u>''HIGH RISK''</u>''' | | '''<u>''HIGH RISK''</u>''' | ||
| Roprinerole, Pramipexole | | Roprinerole, Pramipexole | ||
| Delirium, orthostatic hypotension | | Delirium, orthostatic hypotension | ||
|- | |- | ||
| Parkinson's Disease - MAOI-B Inhibitors | | Parkinson's Disease - MAOI-B Inhibitors | ||
| '''<u>''HIGH RISK''</u>''' | | '''<u>''HIGH RISK''</u>''' | ||
| Selegiline | | Selegiline | ||
| Orthostatic hypotension (Difficult to assess due to high falls risk in PD as the disease process) | | Orthostatic hypotension (Difficult to assess due to high falls risk in PD as the disease process) | ||
|- | |- | ||
| Muscle Relaxant | | Muscle Relaxant | ||
| '''<u>''MODERATE RISK''</u>''' | | '''<u>''MODERATE RISK''</u>''' | ||
| Baclofen | | Baclofen | ||
| Reduced muscle tone, sedative | | Reduced muscle tone, sedative | ||
|- | |- | ||
| Vestibular Sedative | | Vestibular Sedative | ||
| '''<u>''POSSIBLE CAUSES''</u>''' | | '''<u>''POSSIBLE CAUSES''</u>''' | ||
| Prochlorperazine, Cinnarazine, Betahistine | | Prochlorperazine, Cinnarazine, Betahistine | ||
| Prochlor... - Dopamine agonist which may cause movement disorder in long term, sedating | | Prochlor... - Dopamine agonist which may cause movement disorder in long term, sedating | ||
|- | |- | ||
| Anticholinergics acting on Bladder | | Anticholinergics acting on Bladder | ||
| '''<u>''POSSIBLE CAUSES''</u>''' | | '''<u>''POSSIBLE CAUSES''</u>''' | ||
| Oxybutinin, Solifenacin, Tolterodine, Solifenacin | | Oxybutinin, Solifenacin, Tolterodine, Solifenacin | ||
| Known CNS effects. | | Known CNS effects. | ||
|} | |} | ||
Line 116: | Line 116: | ||
<br><br><br><br><br><br><br><br><br><br><br><br><br> | <br><br><br><br><br><br><br><br><br><br><br><br><br> | ||
| | ||
| | ||
| | ||
| | ||
| | ||
<br> | |||
<br> | |||
<br> | |||
<br> | |||
<br> | |||
<br> | |||
<br> | |||
<br> | |||
<br> | |||
| |||
| |||
<br> | |||
Line 144: | Line 156: | ||
| {| border="1" cellspacing="1" cellpadding="1" width="900" | ||
|+ Drugs Acting on the heart and Circulation<ref name="FallSafe" /> | |||
| |- | ||
| '''Medication Group''' | |||
< | | '''Overall Risk Category''' | ||
| '''Commonly Used Medications''' | |||
| '''Effect of Risk''' | |||
|- | |||
| Alpha Receptor blockers | |||
| '''''<u>HIGH RISK</u> | |||
| Doxasozin, Tamsulosin, Indoramin | |||
| Severe orthostatic hypotension, urinary retention | |||
|- | |||
| Centreally Acting Alpha-2-Receptor Agonsits | |||
| '''<u>''HIGH RISK''</u>''' | |||
| Clonidine, Moxonidine | |||
| Severe orthostatic hypotension, sedating | |||
|- | |||
| Thiazide Diuretics | |||
| '''<u>''HIGH RISK''</u>''' | |||
| Bendroflumethiazide, Metolazone | |||
| Weakness due to low potassium, hyponatraemia, orthostatic hypotension | |||
|- | |||
| Loop Diuretic | |||
| '''<u>''MODERATE RISK''</u>''' | |||
| Furosemide, Bumetanide | |||
| Dehydration, hypotension, low potassium and sodium | |||
|- | |||
| Angiotensin Converting Enzyme Inhibitors (ACEIs) | |||
| '''<u>''HIGH RISK''</u>''' | |||
| Lisinopril, Ramipril -opril | |||
| Rely upon kidney elimination and accumulate can cause failure, dehydration. | |||
|- | |||
| Angiotensin Receptor Blockers (ARBs) | |||
| '''<u>''MODERATE RISK''</u>''' | |||
| Losartan or similar -tan | |||
| Hypotension | |||
|- | |||
| Beta Blockers | |||
| '''<u>''HIGH RISK''</u>''' | |||
| Atenolol, Propranolol, Sotalol | |||
| Bradycardia, hypotension, carotid sinus hypersensitivity, vasovagal syndrome | |||
|- | |||
| Antianginals | |||
| '''<u>''HIGH RISK''</u>''' | |||
| Glyceryl Trinitrate (GTN), Isosorbide Mononitrate, Nico<span id="fck_dom_range_temp_1421250129966_530" />rnadil | |||
| Sudden hypotension | |||
|- | |||
| Calcium Channel Blockers | |||
| '''<u>''MODERATE RISK''</u>''' | |||
| Amlodipine, Felodipine, Diltiazem, Verapamil | |||
| Hypotension, bradycardia | |||
|- | |||
| Other Antidysrhythmics | |||
| '''<u>''MODERATE RISK''</u>''' | |||
| Digoxin, Flecainide, Amiodarone | |||
| Bradycardia, arrythmias | |||
|- | |||
| Acetylcholinersterase Inhibitors (For Dementia) | |||
| '''<u>''POSSIBLE CAUSES''</u>''' | |||
| Rivastigmine, Donepezil, galantamine | |||
| Bradycardia and syncope | |||
|} | |||
== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed]) == | == Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed]) == |
Revision as of 17:45, 14 January 2015
Original Editors - Scott Buxton
Top Contributors -Scott Buxton, Lucinda hampton, Sai Kripa, Kim Jackson, WikiSysop, Evan Thomas and Chelsea Mclene
What is a Fall?[edit | edit source]
What is Polypharmacy?[edit | edit source]
Medications Associated with Increased Risk of Falls[edit | edit source]
Medication Group | Overall Risk Category | Commonly Used Medications | Effects on Risk |
Sedatives |
HIGH RISK Can cause falls alone |
Lorazepam, Temazepam, Nitrazepam similar -epamsuffix |
Drowsiness, slows reactions, impaired balance. |
Sedating Antidepressants |
HIGH RISK Can cause falls alone |
Amitriptyline, Nortriptyline | Orthostatic hypotension, drowsiness, slow reactions. DOUBLE THE RATE OF FALLS |
Monoamine Oxidase Inhibitors |
HIGH RISK Can cause falls alone |
Phenelzine, Moclobemide | Severe orthostatic hypotension |
For Psychosis Agitation |
HIGH RISK Can cause falls alone |
Haloperidol, Chlorpromazine, Olanzapine | Orthostatic hypotension, slow reflexes, loss of balance |
Selective Serotonin Reuptake Inhibitors (SSRI) and Serotonin and Noradrenaline Reuptake Inhibitor )SNRI) |
MODERATE RISK Can cause falls in combination |
Fluoxetine, Sertaline, Paroxetine, Venlafaxine, Duloetine | Increased risk of falls with fractures, orthostatic hypotension, bradycardia, impaired sleep quality |
Opiate Analegsics |
HIGH RISK Can cause falls alone |
Codeine, Morphine, Tramadol | Sedates, slows reactions, impairs balance, delirium |
Anti Epileptics | HIGH RISK | Phenytoin, Carbamazepine, Phenobarbitone | Cerebellar damage, ataxia, slowed reactions |
MODERATE RISK | Sodium Valporate, Gabapentin | Some association with falls risk | |
Parkinson's Disease - Dopamine Agonists | HIGH RISK | Roprinerole, Pramipexole | Delirium, orthostatic hypotension |
Parkinson's Disease - MAOI-B Inhibitors | HIGH RISK | Selegiline | Orthostatic hypotension (Difficult to assess due to high falls risk in PD as the disease process) |
Muscle Relaxant | MODERATE RISK | Baclofen | Reduced muscle tone, sedative |
Vestibular Sedative | POSSIBLE CAUSES | Prochlorperazine, Cinnarazine, Betahistine | Prochlor... - Dopamine agonist which may cause movement disorder in long term, sedating |
Anticholinergics acting on Bladder | POSSIBLE CAUSES | Oxybutinin, Solifenacin, Tolterodine, Solifenacin | Known CNS effects. |
Medication Group | Overall Risk Category | Commonly Used Medications | Effect of Risk |
Alpha Receptor blockers | HIGH RISK | Doxasozin, Tamsulosin, Indoramin | Severe orthostatic hypotension, urinary retention |
Centreally Acting Alpha-2-Receptor Agonsits | HIGH RISK | Clonidine, Moxonidine | Severe orthostatic hypotension, sedating |
Thiazide Diuretics | HIGH RISK | Bendroflumethiazide, Metolazone | Weakness due to low potassium, hyponatraemia, orthostatic hypotension |
Loop Diuretic | MODERATE RISK | Furosemide, Bumetanide | Dehydration, hypotension, low potassium and sodium |
Angiotensin Converting Enzyme Inhibitors (ACEIs) | HIGH RISK | Lisinopril, Ramipril -opril | Rely upon kidney elimination and accumulate can cause failure, dehydration. |
Angiotensin Receptor Blockers (ARBs) | MODERATE RISK | Losartan or similar -tan | Hypotension |
Beta Blockers | HIGH RISK | Atenolol, Propranolol, Sotalol | Bradycardia, hypotension, carotid sinus hypersensitivity, vasovagal syndrome |
Antianginals | HIGH RISK | Glyceryl Trinitrate (GTN), Isosorbide Mononitrate, Nicornadil | Sudden hypotension |
Calcium Channel Blockers | MODERATE RISK | Amlodipine, Felodipine, Diltiazem, Verapamil | Hypotension, bradycardia |
Other Antidysrhythmics | MODERATE RISK | Digoxin, Flecainide, Amiodarone | Bradycardia, arrythmias |
Acetylcholinersterase Inhibitors (For Dementia) | POSSIBLE CAUSES | Rivastigmine, Donepezil, galantamine | Bradycardia and syncope |
Recent Related Research (from Pubmed)[edit | edit source]
References[edit | edit source]
- ↑ 1.0 1.1 Darowski A. Dwight J. Reynolds J. Medicines and Falls in Hospital: Guidance Sheet [ONLINE] available from https://www.rcplondon.ac.uk/sites/default/files/documents/medicines-and-falls2.pdf date accessed 14/01/2015