2023 AGS Beers Criteria Updates
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Questions and Answers

What is the primary concern associated with the chronic use of antipsychotics in older adults?

  • Increased cognitive function
  • Enhanced memory retention
  • Increased risk of stroke (correct)
  • Improved pain management

What is a recommended approach when managing pain in older adults to minimize opioid use?

  • Use opioids as the first line of treatment
  • Use validated pain assessment tools (correct)
  • Incorporate only drug-based interventions
  • Limit assessment to non-drug approaches only

Why should anticholinergics be avoided in older adults?

  • They are effective pain relievers
  • They prevent stroke risk
  • They can cause adverse CNS effects (correct)
  • They enhance cognitive abilities

Which of the following statements about benzodiazepines is correct?

<p>They should be avoided in older adults due to cognitive effects (A)</p> Signup and view all the answers

What aspect of opioid administration in older adults is highlighted by emerging data?

<p>Association with delirium (D)</p> Signup and view all the answers

What is the recommendation regarding aspirin for the primary prevention of cardiovascular disease in older adults?

<p>Deprescribing should be considered for those already taking it. (D)</p> Signup and view all the answers

What change was made regarding rivaroxaban in the 2023 AGS Beers Criteria®?

<p>The recommendation has changed from 'use with caution' to 'avoid'. (B)</p> Signup and view all the answers

Why was rivaroxaban's recommendation changed?

<p>Observational studies indicate a higher risk of bleeding. (C)</p> Signup and view all the answers

What does Table 7 list in the 2023 AGS Beers Criteria®?

<p>Drugs with strong anticholinergic properties. (C)</p> Signup and view all the answers

Which of the following anticoagulants poses a higher risk of bleeding compared to apixaban?

<p>Dabigatran (B)</p> Signup and view all the answers

What has been clarified in the special box summarizing the criteria for anticoagulants?

<p>It outlines the criteria for warfarin, rivaroxaban, and dabigatran. (A)</p> Signup and view all the answers

What is the overall stance of the AGS Executive Committee on aspirin use in older adults?

<p>It should be avoided for primary prevention of cardiovascular disease. (D)</p> Signup and view all the answers

What is stated regarding older adults already on aspirin for primary prevention?

<p>Deprescribing should be considered based on new data. (B)</p> Signup and view all the answers

Under what circumstances should antipsychotics be used for behavioral problems in older adults?

<p>After nonpharmacologic interventions have failed or are not possible (C)</p> Signup and view all the answers

What is the recommended approach regarding the dosage of corticosteroids for older adults?

<p>Use the lowest possible dose for the shortest duration (C)</p> Signup and view all the answers

What should be considered when using antipsychotics in older adults?

<p>Periodic deprescribing attempts should be assessed (D)</p> Signup and view all the answers

Which of the following medications are categorized under antipsychotics according to the AGS 2023 Beers Criteria?

<p>Aripiprazole (A)</p> Signup and view all the answers

What is a key factor in the administration of benzodiazepines to older adults?

<p>Nonbenzodiazepine alternatives must be used when possible (C)</p> Signup and view all the answers

When should periodic deprescribing attempts be conducted for patients on antipsychotics?

<p>To assess ongoing need and lowest effective dose (A)</p> Signup and view all the answers

Which of the following medications could potentially lead to delirium and should be monitored carefully?

<p>Corticosteroids (D)</p> Signup and view all the answers

What should be prioritized when treating older adults with pharmacologic options?

<p>Behavioral interventions before considering medications (D)</p> Signup and view all the answers

What is the recommended practice when prescribing certain medications for schizophrenia and bipolar disorder?

<p>Prescribe the lowest effective dose for the shortest possible duration. (C)</p> Signup and view all the answers

Which forms of corticosteroids are excluded from the recommendation?

<p>Inhaled and topical forms. (C)</p> Signup and view all the answers

What is the significance of the ratings of quality of evidence and strength of recommendation?

<p>They apply to all drugs and recommendations within each criterion. (C)</p> Signup and view all the answers

What should be considered when prescribing oral and parenteral corticosteroids?

<p>They should be used in the lowest effective dose and for the shortest duration. (D)</p> Signup and view all the answers

Under the Beers Criteria, how are drugs listed within specific classes treated?

<p>All drugs within the class are considered inappropriate unless stated otherwise. (B)</p> Signup and view all the answers

What is noted about the selective peripheral alpha-1 blockers in the Beers Criteria?

<p>Data are limited, but they may also apply as potentially inappropriate. (A)</p> Signup and view all the answers

What should be a priority when treating conditions like exacerbation of COPD with corticosteroids?

<p>Maintaining the lowest effective dosage for as short a duration as possible. (A)</p> Signup and view all the answers

What implication does the Beers Criteria hold for drugs used in older adults?

<p>Medications should be continually evaluated for appropriateness. (D)</p> Signup and view all the answers

Which drug carries a significant increased risk of gastrointestinal bleeding compared to warfarin when used for long-term treatment?

<p>Dabigatran (C)</p> Signup and view all the answers

What is the primary concern when using Dabigatran for long-term treatment in older adults?

<p>Increased risk of GI bleeding (B)</p> Signup and view all the answers

Prasugrel may be used with caution in which demographic, particularly due to the risk of major bleeding?

<p>Adults 75 years old and older (A)</p> Signup and view all the answers

What should be closely monitored when starting or changing dosages of selected antidepressants in older adults?

<p>Sodium levels (B)</p> Signup and view all the answers

When considering the use of DOACs for long-term treatment, which drug is advised to be chosen with caution over others like apixaban?

<p>Dabigatran (C)</p> Signup and view all the answers

What may offset the risk of major bleeding when using Ticagrelor in older adults?

<p>Lowering the dosage to 5 mg (B)</p> Signup and view all the answers

Among the listed antidepressants, which class is known to potentially exacerbate SIADH or cause hyponatremia?

<p>SSRIs (A)</p> Signup and view all the answers

Which rationale supports the cautious selection of Dabigatran over other direct oral anticoagulants (DOACs) in older adults?

<p>Increased risk of gastrointestinal bleeding (D)</p> Signup and view all the answers

Flashcards

Beers Criteria® Updates

The American Geriatrics Society (AGS) has updated the Beers Criteria® to provide guidelines for prescribing medications to older adults.

2023 Beers Criteria® Update Focus

The 2023 update focuses on drug classes and specific recommendations for medication use in older adults.

Anti-coagulant Recommendations

The criteria for anti-coagulants like warfarin, rivaroxaban, and dabigatran have been revised based on their safety and effectiveness in older adults.

Rivaroxaban Recommendation

The recommendation for rivaroxaban for long-term treatment of non-valvular atrial fibrillation and venous thromboembolism (VTE) has changed from "use with caution" to "avoid".

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Dabigatran Recommendation

The recommendation for dabigatran for similar conditions is now considered to be "use with caution" when compared to other DOACs.

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Antipsychotics for Dementia

Antipsychotics should be avoided for behavioral problems of dementia or delirium unless non-pharmacological options have failed or are not possible.

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Drug Class Guidance

The updated criteria provide guidance on the risks and recommended approaches to medication use for various drug classes in older adults.

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Anticholinergic Avoidance

Anticholinergics, which affect the nervous system, are generally avoided due to their potential side effects in older adults.

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Specific Anticholinergic Criteria

Specific criteria are offered for individual drugs within the anticholinergic class, taking into account their specific risks and benefits.

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Opioids and Delirium

The criteria highlight the association between opioid administration and delirium in older adults, advocating for a balanced approach to pain management.

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Benzodiazepine Use

The criteria recommend using the lowest effective dose and the shortest necessary duration for benzodiazepine use in older adults.

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Corticosteroids Use

Similar to benzodiazepines, corticosteroids should be used at the lowest effective dose for the shortest possible duration.

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Antidepressants and SIADH

The potential for some antidepressants, like mirtazapine, SNRIs, and SSRIs, to exacerbate or cause SIADH (Syndrome of Inappropriate Antidiuretic Hormone Secretion) or hyponatremia is highlighted in the criteria.

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Prasugrel and Ticagrelor Risks

Prasugrel and ticagrelor are blood-thinning drugs that are associated with an increased risk of major bleeding in older adults, especially those 75 years and older.

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Prasugrel and Ticagrelor Recommendations

The criteria recommend caution with the use of prasugrel and ticagrelor in older adults, and consideration for a lower dose of prasugrel (5 mg) for those 75 years and older.

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Anti-Coagulant

A drug that reduces the risk of forming blood clots.

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Non-valvular Atrial Fibrillation

A non-valvular atrial fibrillation is a type of irregular heartbeat that occurs when the electrical signals in the heart don't work properly. It's not related to a heart valve problem.

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Venous Thromboembolism (VTE)

Venous Thromboembolism (VTE) is a blood clot that forms in a deep vein, often in the legs.

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Delirium

Delirium is a state of confusion and disorientation that can happen suddenly. It is usually a temporary condition but can be serious.

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Potentially Inappropriate Medication

A drug that can be dangerous to an older adult.

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Direct Oral Anticoagulants (DOACs)

Direct oral anticoagulants (DOACs) are a newer type of blood thinner that can be taken by mouth.

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Anticholinergics

Anticholinergics are medications that block the effects of a chemical called acetylcholine. They are used to treat a variety of conditions, including asthma, overactive bladder, and Parkinson's disease.

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Opioids

Opioids are a type of medication used to relieve pain. They can be very effective in treating severe pain, but they can also be addictive.

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Benzodiazepines

Benzodiazepines are a type of medicine used to treat anxiety, insomnia, and seizures.

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Corticosteroids

Corticosteroids are a type of medicine used to suppress the immune system and reduce inflammation.

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Antidepressants

Antidepressants are medications used to treat depression and anxiety.

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Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)

A condition where the body produces too much of a hormone that controls water retention, leading to low sodium levels in the blood.

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Hyponatremia

A lower than normal level of sodium in the blood.

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Study Notes

2023 AGS Beers Criteria® Updates

  • The American Geriatrics Society (AGS) has updated the Beers Criteria® for potentially inappropriate medications in older adults.
  • The 2023 update focusses on drug classes and recommendations for use in older adults.
  • Changes in anti-coagulant recommendations: The criteria for anti-coagulants like warfarin, rivaroxaban, and dabigatran have been revised.
  • Rivaroxaban: The recommendation for rivaroxaban for long-term treatment of non-valvular atrial fibrillation and venous thromboembolism (VTE) has changed from "use with caution" to "avoid".
  • Dabigatran: The recommendation for dabigatran for similar conditions is now considered to be "use with caution" when compared to other DOACs.
  • Antipsychotic use for dementia: The criteria now recommend that antipsychotics should be avoided for behavioral problems of dementia or delirium unless non-pharmacological options have failed or are not possible.
  • The updated criteria also include information about various drug classes and their impact on older adults, particularly highlighting risks and recommended approaches to use.
  • Anticholinergics: These are generally avoided due to their CNS effects, and specific criteria are offered for individual drugs in this class.
  • Opioids: The criteria highlight the potential association between opioid administration and delirium and advocate for a balanced approach to pain management.
  • Benzodiazepines: The criteria recommend using the lowest effective dose and the shortest duration for benzodiazepine use in older adults.
  • Corticosteroids: Similar recommendations for lowest effective doses and shortest duration are made for corticosteroids.
  • Antidepressants: The criteria highlight the potential for selected antidepressants like mirtazapine, SNRIs, and SSRIs to exacerbate or cause SIADH or hyponatremia. Sodium levels should be monitored closely when starting or adjusting dosages.
  • Prasugrel and Ticagrelor: These drugs are associated with an increased risk of major bleeding in older adults, especially those 75 years and older. The criteria recommend caution with their use in older adults, and consideration for a lower dose of prasugrel (5 mg) for those 75 years and older.

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Related Documents

American Geriatrics Society 2023 updated AGS Beers Criteria PDF

Description

Explore the latest updates to the AGS Beers Criteria for potentially inappropriate medications in older adults. This quiz focuses on significant changes, including anticoagulant recommendations and guidance on antipsychotic use for dementia. Test your knowledge on these essential updates that impact prescribing practices for older patients.

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