Medication and Falls: Difference between revisions
Scott Buxton (talk | contribs) No edit summary |
Scott Buxton (talk | contribs) No edit summary |
||
Line 9: | Line 9: | ||
== Medications Associated with Increased Risk of Falls == | == Medications Associated with Increased Risk of Falls == | ||
As physiotherapists it is important to be aware of which medications can impact on our patients safety, medication is obviously not within a physiotherapist job role specifically however knowing what the postential impact of some medications is can be very valuable. | |||
{| border="1" cellspacing="1" summary="Adapted from The FallSafe Project" cellpadding="1" width="900" align="left" | {| border="1" cellspacing="1" summary="Adapted from The FallSafe Project" cellpadding="1" width="900" align="left" | ||
Line 114: | Line 116: | ||
| | ||
<br><br><br><br><br><br><br><br> | <br><br><br><br><br><br><br><br> | ||
<br> | <br> | ||
{| border="1" cellspacing="1" cellpadding="1" width="900" | {| border="1" cellspacing="1" cellpadding="1" width="900" | ||
|+ Drugs Acting on the heart and Circulation<ref name="FallSafe" /> | |+ Drugs Acting on the heart and Circulation<ref name="FallSafe" /> | ||
|- | |- | ||
| '''Medication Group''' | | '''Medication Group''' | ||
| '''Overall Risk Category''' | | '''Overall Risk Category''' | ||
| '''Commonly Used Medications''' | | '''Commonly Used Medications''' | ||
| '''Effect of Risk''' | | '''Effect of Risk''' | ||
|- | |- | ||
| Alpha Receptor blockers | | Alpha Receptor blockers | ||
| '''''<u>HIGH RISK</u> | | '''''<u>HIGH RISK</u>''''' | ||
| Doxasozin, Tamsulosin, Indoramin | | Doxasozin, Tamsulosin, Indoramin | ||
| Severe orthostatic hypotension, urinary retention | | Severe orthostatic hypotension, urinary retention | ||
|- | |- | ||
| Centreally Acting Alpha-2-Receptor Agonsits | | Centreally Acting Alpha-2-Receptor Agonsits | ||
| '''<u>''HIGH RISK''</u>''' | | '''<u>''HIGH RISK''</u>''' | ||
| Clonidine, Moxonidine | | Clonidine, Moxonidine | ||
| Severe orthostatic hypotension, sedating | | Severe orthostatic hypotension, sedating | ||
|- | |- | ||
| Thiazide Diuretics | | Thiazide Diuretics | ||
| '''<u>''HIGH RISK''</u>''' | | '''<u>''HIGH RISK''</u>''' | ||
| Bendroflumethiazide, Metolazone | | Bendroflumethiazide, Metolazone | ||
| Weakness due to low potassium, hyponatraemia, orthostatic hypotension | | Weakness due to low potassium, hyponatraemia, orthostatic hypotension | ||
|- | |- | ||
| Loop Diuretic | | Loop Diuretic | ||
| '''<u>''MODERATE RISK''</u>''' | | '''<u>''MODERATE RISK''</u>''' | ||
| Furosemide, Bumetanide | | Furosemide, Bumetanide | ||
| Dehydration, hypotension, low potassium and sodium | | Dehydration, hypotension, low potassium and sodium | ||
|- | |- | ||
| Angiotensin Converting Enzyme Inhibitors (ACEIs) | | Angiotensin Converting Enzyme Inhibitors (ACEIs) | ||
| '''<u>''HIGH RISK''</u>''' | | '''<u>''HIGH RISK''</u>''' | ||
| Lisinopril, Ramipril -opril | | Lisinopril, Ramipril -opril | ||
| Rely upon kidney elimination and accumulate can cause failure, dehydration. | | Rely upon kidney elimination and accumulate can cause failure, dehydration. | ||
|- | |- | ||
| Angiotensin Receptor Blockers (ARBs) | | Angiotensin Receptor Blockers (ARBs) | ||
| '''<u>''MODERATE RISK''</u>''' | | '''<u>''MODERATE RISK''</u>''' | ||
| Losartan or similar -tan | | Losartan or similar -tan | ||
| Hypotension | | Hypotension | ||
|- | |- | ||
| Beta Blockers | | Beta Blockers | ||
| '''<u>''HIGH RISK''</u>''' | | '''<u>''HIGH RISK''</u>''' | ||
| Atenolol, Propranolol, Sotalol | | Atenolol, Propranolol, Sotalol | ||
| Bradycardia, hypotension, carotid sinus hypersensitivity, vasovagal syndrome | | Bradycardia, hypotension, carotid sinus hypersensitivity, vasovagal syndrome | ||
|- | |- | ||
| Antianginals | | Antianginals | ||
| '''<u>''HIGH RISK''</u>''' | | '''<u>''HIGH RISK''</u>''' | ||
| Glyceryl Trinitrate (GTN), Isosorbide Mononitrate, Nico | | Glyceryl Trinitrate (GTN), Isosorbide Mononitrate, Nico | ||
| Sudden hypotension | | Sudden hypotension | ||
|- | |- | ||
| Calcium Channel Blockers | | Calcium Channel Blockers | ||
| '''<u>''MODERATE RISK''</u>''' | | '''<u>''MODERATE RISK''</u>''' | ||
| Amlodipine, Felodipine, Diltiazem, Verapamil | | Amlodipine, Felodipine, Diltiazem, Verapamil | ||
| Hypotension, bradycardia | | Hypotension, bradycardia | ||
|- | |- | ||
| Other Antidysrhythmics | | Other Antidysrhythmics | ||
| '''<u>''MODERATE RISK''</u>''' | | '''<u>''MODERATE RISK''</u>''' | ||
| Digoxin, Flecainide, Amiodarone | | Digoxin, Flecainide, Amiodarone | ||
| Bradycardia, arrythmias | | Bradycardia, arrythmias | ||
|- | |- | ||
| Acetylcholinersterase Inhibitors (For Dementia) | | Acetylcholinersterase Inhibitors (For Dementia) | ||
| '''<u>''POSSIBLE CAUSES''</u>''' | | '''<u>''POSSIBLE CAUSES''</u>''' | ||
| Rivastigmine, Donepezil, galantamine | | Rivastigmine, Donepezil, galantamine | ||
| Bradycardia and syncope | | Bradycardia and syncope | ||
|} | |} |
Revision as of 17:49, 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]
As physiotherapists it is important to be aware of which medications can impact on our patients safety, medication is obviously not within a physiotherapist job role specifically however knowing what the postential impact of some medications is can be very valuable.
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, Nico | 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