Medication and Falls: Difference between revisions

No edit summary
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&nbsp;RISK'''''</u>
<u>'''''HIGH&nbsp;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&nbsp;RISK''</u>'''
'''<u>''HIGH&nbsp;RISK''</u>'''  


Can cause falls alone
Can cause falls alone


| Amitriptyline, Nortriptyline
| Amitriptyline, Nortriptyline  
| Orthostatic hypotension, drowsiness, slow reactions. '''DOUBLE&nbsp;THE&nbsp;RATE&nbsp;OF&nbsp;FALLS'''
| Orthostatic hypotension, drowsiness, slow reactions. '''DOUBLE&nbsp;THE&nbsp;RATE&nbsp;OF&nbsp;FALLS'''
|-
|-
| Monoamine Oxidase Inhibitors
| Monoamine Oxidase Inhibitors  
|  
|  
'''<u>''HIGH&nbsp;RISK''</u>'''
'''<u>''HIGH&nbsp;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&nbsp;RISK''</u>'''
'''<u>''HIGH&nbsp;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&nbsp;RISK''</u>'''
'''<u>''MODERATE&nbsp;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&nbsp;RISK''</u>'''
| '''<u>''HIGH&nbsp;RISK''</u>'''  
| Phenytoin, Carbamazepine, Phenobarbitone
| Phenytoin, Carbamazepine, Phenobarbitone  
| Cerebellar damage, ataxia, slowed reactions
| Cerebellar damage, ataxia, slowed reactions
|-
|-
|  
|  
| '''<u>''MODERATE&nbsp;RISK''</u>'''
| '''<u>''MODERATE&nbsp;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&nbsp;RISK''</u>'''
| '''<u>''HIGH&nbsp;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&nbsp;RISK''</u>'''
| '''<u>''HIGH&nbsp;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&nbsp;RISK''</u>'''
| '''<u>''MODERATE&nbsp;RISK''</u>'''  
| Baclofen
| Baclofen  
| Reduced muscle tone, sedative
| Reduced muscle tone, sedative
|-
|-
| Vestibular Sedative
| Vestibular Sedative  
| '''<u>''POSSIBLE&nbsp;CAUSES''</u>'''
| '''<u>''POSSIBLE&nbsp;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&nbsp;CAUSES''</u>'''
| '''<u>''POSSIBLE&nbsp;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>


&nbsp;
&nbsp;  


&nbsp;
&nbsp;  


&nbsp;
&nbsp;  


&nbsp;
&nbsp;  


&nbsp;
&nbsp;  


<br>


<br>


<br>


<br>


<br>


<br>


<br>


<br>


<br>


&nbsp;


&nbsp;


<br>




Line 144: Line 156:




&nbsp;
{| border="1" cellspacing="1" cellpadding="1" width="900"
 
|+ Drugs Acting on the heart and Circulation<ref name="FallSafe" />
&nbsp;
|-
 
| '''Medication Group'''
<br>
| '''Overall Risk Category'''
| '''Commonly Used Medications'''
| '''Effect of Risk'''
|-
| Alpha Receptor blockers
| '''''<u>HIGH&nbsp;RISK</u>
| Doxasozin, Tamsulosin, Indoramin
| Severe orthostatic hypotension, urinary retention
|-
| Centreally Acting Alpha-2-Receptor Agonsits
| '''<u>''HIGH&nbsp;RISK''</u>'''
| Clonidine, Moxonidine
| Severe orthostatic hypotension, sedating
|-
| Thiazide Diuretics
| '''<u>''HIGH&nbsp;RISK''</u>'''
| Bendroflumethiazide, Metolazone
| Weakness due to low potassium, hyponatraemia, orthostatic hypotension
|-
| Loop Diuretic
| '''<u>''MODERATE&nbsp;RISK''</u>'''
| Furosemide, Bumetanide
| Dehydration, hypotension, low potassium and sodium
|-
| Angiotensin Converting Enzyme Inhibitors (ACEIs)
| '''<u>''HIGH&nbsp;RISK''</u>'''
| Lisinopril, Ramipril -opril
| Rely upon kidney elimination and accumulate can cause failure, dehydration.
|-
| Angiotensin Receptor Blockers (ARBs)
| '''<u>''MODERATE&nbsp;RISK''</u>'''
| Losartan or similar -tan
| Hypotension
|-
| Beta Blockers
| '''<u>''HIGH&nbsp;RISK''</u>'''
| Atenolol, Propranolol, Sotalol
| Bradycardia, hypotension, carotid sinus hypersensitivity, vasovagal syndrome
|-
| Antianginals
| '''<u>''HIGH&nbsp;RISK''</u>'''
| Glyceryl Trinitrate (GTN), Isosorbide Mononitrate, Nico<span id="fck_dom_range_temp_1421250129966_530" />rnadil
| Sudden hypotension
|-
| Calcium Channel Blockers
| '''<u>''MODERATE&nbsp;RISK''</u>'''
| Amlodipine, Felodipine, Diltiazem, Verapamil
| Hypotension, bradycardia
|-
| Other Antidysrhythmics
| '''<u>''MODERATE&nbsp;RISK''</u>'''
| Digoxin, Flecainide, Amiodarone
| Bradycardia, arrythmias
|-
| Acetylcholinersterase Inhibitors (For Dementia)
| '''<u>''POSSIBLE&nbsp;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

What is a Fall?[edit | edit source]

What is Polypharmacy?[edit | edit source]

Medications Associated with Increased Risk of Falls[edit | edit source]

Psychotropic Drugs and Falls Risk[1]
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 Acting on the heart and Circulation[1]
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]

Failed to load RSS feed from http://www.ncbi.nlm.nih.gov/entrez/eutils/erss.cgi?rss_guid=1rWUB7RlDfIVxfi4u-5OlQyiEOSt8rs5X9V7mibCvW_H00AAOp|charset=UTF-8|short|max=10: Error parsing XML for RSS

References[edit | edit source]

  1. 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