Module 3: The Drug Regimen Review - College of Pharmacy ...
Module 3: The Drug Regimen Review - College of Pharmacy ...
Module 3: The Drug Regimen Review - College of Pharmacy ...
Create successful ePaper yourself
Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.
Tricyclic<br />
antidepressants<br />
(TCAs), e.g., <br />
amitriptyline<br />
amoxapine<br />
doxepin<br />
combinationproduc<br />
ts, e.g., o<br />
amitriptyline and<br />
chlordiazepoxide o<br />
amitripytline and<br />
perphenazine<br />
Antidiabetic Medications<br />
Insulin and oral<br />
hypoglycemics, e.g., <br />
acarbose<br />
acetohexamide<br />
chlorpropamide<br />
glimepiride<br />
glipizide<br />
glyburide<br />
Metformin<br />
repaglinide<br />
rosiglitazone<br />
tolazamide<br />
tolbutamideIncluding<br />
combination products,<br />
e.g.,<br />
rosiglitazone/metformin<br />
<br />
glyburide/metformin<br />
glipizide/metformin <br />
pioglitazone/metformin<br />
selegiline (MAO-B inhibitors) utilized for<br />
Parkinson’s Disease, unless used in doses greater<br />
than 10 mg per day<br />
Interactions<br />
Should not be administered together or in rapid<br />
succession with other MAO inhibitors, tricyclic<br />
antidepressants, bupropion, SSRIs, buspirone,<br />
sympathomimetics, meperidine, triptans, and other<br />
medications that affect serotonin or<br />
norepinephrine<br />
Indications<br />
Because <strong>of</strong> strong anticholinergic and sedating<br />
properties, TCAs and combination products are<br />
rarely the medication <strong>of</strong> choice in older<br />
individuals<br />
Exception: Use <strong>of</strong> TCAs may be appropriate<br />
if:<br />
o <strong>The</strong> resident is being treated for<br />
neurogenic pain (e.g., trigeminal<br />
neuralgia, peripheral neuropathy),<br />
based on documented evidence to<br />
support the diagnosis; and<br />
o <strong>The</strong> relative benefits outweigh the risks<br />
and other, safer agents including non-<br />
pharmacological interventions or<br />
alternative therapies are not indicated<br />
or have been considered, attempted, and<br />
failed<br />
Adverse Consequences<br />
Compared to other categories <strong>of</strong> antidepressants,<br />
TCAs cause significant anticholinergic side effects<br />
and sedation (nortriptyline and desipramine are<br />
less problematic)<br />
Monitoring<br />
Use <strong>of</strong> anti-diabetic medications should include<br />
monitoring (for example, periodic blood sugars)<br />
for effectiveness based on desired goals for that<br />
individual and to identify complications <strong>of</strong><br />
treatment such as hypoglycemia, impaired renal<br />
function<br />
NOTE: Continued or long-term need for sliding<br />
scale insulin for non-emergency<br />
coverage may indicate inadequate blood<br />
sugar control<br />
Residents on rosiglitazone should be monitored for<br />
visual deterioration due to new onset and/or<br />
worsening <strong>of</strong> macular edema in diabetic patients<br />
Adverse Consequences<br />
Metformin has been associated with the<br />
development <strong>of</strong> lactic acidosis (a potentially life<br />
threatening metabolic disorder), which is more<br />
likely to occur in individuals with:<br />
o serum creatinine > 1.5 mg/dl in males or ><br />
1.4 mg/dl in females<br />
o abnormal creatinine clearance from any<br />
cause, including shock, acute myocardial<br />
infarction, or septicemia<br />
o age > 80 years unless measurement <strong>of</strong>