Medication and Falls

Original Editors - Scott Buxton

Top Contributors -Scott Buxton, Lucinda hampton, Sai Kripa, Kim Jackson, WikiSysop, Evan Thomas and Chelsea Mclene  

What is Polypharmacy?

Polypharmacy is typically defined as the use of more than 3 or 4 medications, 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

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

Psychotropic Drugs and Falls Risk

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

Drugs Acting on the heart and Circulation

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)

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