Potentially inappropriate (risky) drugs at geriatric patients Expert consensus for the Czech Republic 2012
Authors:
E. Topinková 1,3; D. Fialová 1,3; H. Matějovská Kubešová 2,3
Authors‘ workplace:
1. lékařská fakulta UK a Všeobecná fakultní nemocnice, Praha, Geriatrická klinika, Přednostka: prof. MUDr. Eva Topinková, CSc.
1; Lékařská fakulta Masarykovy univerzity, Brno, Klinika interní, geriatrie a všeobecného praktického lékařství, Přednostka: prof. MUDr. Hana Matějovská Kubešová, CSc.
2; Expertní panel:
Koordinátoři: prof. MUDr. Eva Topinková, CSc., PharmDr. Daniela Fialová, PhD.
prof. MUDr. Štefan Alušík, CSc., prim. MUDr. Ivo Bureš, MUDr. Tomáš Doležal, PhD.
prim. MUDr. Ivana Doleželová, MUDr. Božena Jurašková, PhD., MUDr. Jaroslava La
3
Published in:
Prakt. Lék. 2012; 92(1): 11-22
Category:
Reviews
Overview
Demographic population ageing and “geriatrization of medicine” contribute to steadily increasing drug consumption. Therefore, rational prescribing is needed for maximizing of the treatment benefit for the patient and to minimize the risk of adverse drug reactions. Age-related physiological changes and multiple comorbid conditions typical for geriatric patients influence the therapeutic value of many drugs and change their risk/benefit ratio. Medication for which there is pharmacological evidence of increased risk of adverse drug events in frail elderly patients or for which evidence of sufficient benefit is lacking are understood as “potentially inappropriate (risky) medication”. The most widely known are ”Beers’ criteria” from US but also other national criteria of inapproprite medictions for older persons reflecting availability of drugs and specific clinical approaches in individual countries.
In the Czech Republic several pharmacoepidemiologic studies using american and irish criteria reported high prevalence of prescribing errors in senior population, the most prevalent were omission of potentially beneficial drugs and high potentially inappropriate drugs prescribing. Due to differences in availability of potentially inappropriate drugs at the Czech pharmaceutical market and in the spectrum of prescribed inappropriate medications we recommended to develop Czech national criteria of inappropriate prescription in older patients for the use in clinical practice.
In the article we describe the modified Delphi method used for the development of the Czech national criteria based on the consensus of the multidisciplinary expert panel representing
- geriatric medicine,
- internal medicine,
- general practice,
- clinical pharmacy, and
- clinical pharmacology.
Overall, 71 individual medications fulfilled these criteria and were included into final list of the “Czech national criteria for inappropriate medication in older patients”. Medications are listed based on their pharmacological groups:
- central nervous system drugs,
- cardiovascular drugs,
- muscle relaxing and spasmolytic drugs,
- antiemetics and antivertiginous drugs,
- analgesics,
- gastrointestinal tract drugs, and
- other drugs.
However, the newly developed criteria do not represent absolute contraindications for the prescribing of included drugs. The list should alert the prescribing physician not to prescribe these drugs as the first line pharmacotherapy and to limit their prescripton in older patients when possible. When prescribed, patients should be carefully monitored for drug effect and potential adverese events and higher risk acknowledged by the physician. Implementation of the newly developed national criteria may help in decreasing potentially risky prescriptions in geriatric patients and to prevent their negative health and economical consequences.
Key words:
geriatric pharmacotherapy, potentially inappropriate drugs, risk.
Sources
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