Table 3 Potentially inappropriate medications (PIM) identified in the ambulatory and institutionalized elderly pharmacotherapy
Medications prescribed on 345 reimbursed prescriptions delivered to ambulatory elderly | Medications recommended on 91 medical files of the institutionalized elderly | |||||
|---|---|---|---|---|---|---|
Subtype – PIM Reference criteria a : reason to avoid | no. of examples of subtype- PIM | % of the respective subtype- PIM category | % of 159 PIM | no. of examples of subtype- PIM | % of the respective subtype- PIM category | % of 140 PIM |
Misprescribed – PIM | 60 | 87 | ||||
NSAIDs as chronic analgesics in osteoarthritis PRISCUS list –analgesics, anti-inflammatory drugs: – very high risk of gastrointestinal hemorrhage, ulceration, or perforation, which may be fatal – indometacin: central nervous disturbances – phenylbutazone: blood dyscrasia – etoricoxib: cardiovascular contraindications STOPP tool - Musculoskeletal system − NSAID with heart failure − Warfarin and NSAID together | 34 | 56.66 | 21.38 | 31 | 35.63 | 22.14 |
benzodiazepines PRISCUS - sedatives, hypnotic agents: – risk of falling (muscle-relaxing effect) with risk of hip fracture – prolonged reaction times – psychiatric reactions (can also be paradoxical, e.g., agitation, irritability, hallucinations, psychosis) – cognitive impairment – depression | 16 | 26.66 | 10.06 | 21 | 24.13 | 15.00 |
antipsychotics PRISCUS- neuroleptic drugs: – anticholinergic and extrapyramidal side effects (tardive dyskinesia) – parkinsonism – hypotonia – sedation – risk of falling – increased mortality in demented patients | 3 | 5.00 | 1.88 | 18 | 20.68 | 12.85 |
digoxin for heart failure > 0.125 mg/day PRISCUS list- Antiarrhythmic drugs: – elevated glycoside sensitivity (women > men) – risk of intoxication STOPP tool - Cardiovascular system: - digoxin at a long-term dose > 125 μg/day with impaired renal function | 4 | 6.66 | 2.51 | 13 | 14.94 | 9.28 |
anticholinergic drugs (trihexyphenidyl, doxepine) PRISCUS list- Anticholinergic drugs: – anticholinergic side effects (e.g., constipation, dry mouth) – impaired cognitive performance – ECG changes (prolonged QT) PRISCUS list - Tricyclic antidepressants: – peripheral anticholinergic side effects (e.g., constipation, dry mouth, orthostatic hypotension, cardiac arrhythmia) – central anticholinergic side effects (drowsiness, inner unrest, confusion, other types of delirium) – cognitive deficit – increased risk of falling STOPP tool - Central nervous system and psychotropic drugs: – anticholinergics to treat extrapyramidal side effects of neuroleptic medications (risk of anticholinergic toxicity) | 1 | 1.66 | 0.62 | 3 | 3.44 | 2.14 |
Duplicate drug classes (two concurrent NSAIDs, ACE inhibitors, ARBs) STOPP tool - Duplicate drug classes: - any duplicate drug class prescription. | 2 | 3.33 | 1.25 | 1 | 1.14 | 0.71 |
Underprescribed - PIM | 88 | 15 | ||||
underprescribing of statins in coronary vascular disease START tool - Cardiovascular system: - Statin therapy with a documented history of coronary, cerebral or peripheral vascular disease, where the patient’s functional status remains independent for activities of daily living and life expectancy is greater than 5 years | 46 | 52.27 | 28.93 | 1 | 6.66 | 0.71 |
underprescribing of β-blocker with chronic stable angina START tool - Cardiovascular system: - Beta-blocker with chronic stable angina. | 29 | 32.95 | 18.23 | 0 | 0 | 0 |
underprescribing of acenocoumarolb in the presence of chronic atrial fibrillation START tool - Cardiovascular system: - Warfarin in the presence of chronic atrial fibrillation. | 8 | 9.09 | 5.03 | 0 | 0 | 0 |
underprescribing of antihypertensive therapy where systolic blood pressure consistently > 160 mmHg START tool - Cardiovascular system: - Antihypertensive therapy where systolic blood pressure consistently > 160 mmHg. | not applicablec | 7 | 46.66 | 5.00 | ||
underprescribing of ACE inhibitors with chronic heart failure START tool - Cardiovascular system: - ACE inhibitor with chronic heart failure | 3 | 3.40 | 1.88 | 2 | 13.33 | 1.42 |
underprescribing of statins in diabetes mellitus START tool - Endocrine system: - Statin therapy in diabetes mellitus if coexisting major cardiovascular risk factors present | 1 | 1.13 | 0.62 | 4 | 26.66 | 2.85 |
underprescribing of ACE inhibitors following acute myocardial infarction START tool - Cardiovascular system: - ACE inhibitor following acute myocardial infarction | 1 | 1.13 | 0.62 | 1 | 6.66 | 0.71 |
Overprescribed - PIM | 11 | 38 | ||||
overprescribing of anti-dementia drugs, vasodilators, circulation-promoting agentsd PRISCUS - anti-dementia drugs, vasodilators, circulation-promoting agents – no proof of efficacy, unfavorable risk/benefit profile | 11 | 100.00 | 6.91 | 38 | 100.00 | 27.14 |