Medication and Falls: Difference between revisions
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== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed]) == | == Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed]) == | ||
<div class="researchbox"><rss>http://www.ncbi.nlm.nih.gov/entrez/eutils/erss.cgi?rss_guid=1rWUB7RlDfIVxfi4u-5OlQyiEOSt8rs5X9V7mibCvW_H00AAOp | <div class="researchbox"><rss>http://www.ncbi.nlm.nih.gov/entrez/eutils/erss.cgi?rss_guid=1rWUB7RlDfIVxfi4u-5OlQyiEOSt8rs5X9V7mibCvW_H00AAOp</rss></div> | ||
== References == | == References == | ||
Revision as of 11:33, 6 June 2017
Original Editors - Scott Buxton
Top Contributors -Scott Buxton, Lucinda hampton, Sai Kripa, Kim Jackson, WikiSysop, Evan Thomas and Chelsea Mclene
What is Polypharmacy?[edit | edit source]
Polypharmacy is typically defined as the use of more than 3 or 4 medications[1][2], take a moment and think of the number of patients you have that are taking more than 3 medications. Thought also needs to be spent on which types of medications the patient is taking as different classes of drug influence the risk of falls differently.
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 potential impact of some medications can be very valuable. Additionally it is important to know about the medications if you work in a triage role, if you are concerned about the type or number of medications a patient is taking then spend time referring to you medical colleagues in the clinic, writing to their GP or discussing at and MDT meeting.
Psychotropic Drugs[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. |
Drugs Actings on the Heart and Circulation[edit | edit source]
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]
- ↑ Ziere G. Dieleman J. Hofman A. Pol A. van der Cammen T. Stricker B. Polypharmacy and Falls in the Middle Age and Elderly Population. British journal of clinical Pharmacology. 2005:61;218-223
- ↑ Evans J. Drugs and Falls in Later Life. Lancet. 2003; 361:448
- ↑ 3.0 3.1 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