The Bergen District Nursing Home (BEDNURS) study: prevalent medication problems identified by a multidisciplinary expert panel and reported to nursing home physicians according to description of problem, clinical implications, and suggestion for treatment alterations
| Potential medication problems | Clinical implications | Suggestion for treatment alterations |
|---|---|---|
| ACE=angiotensin converting enzyme; NSAID=non-steroidal anti-inflammatory drugs;SSRI=selective serotonin re-uptake inhibitor; ADR=adverse drug reaction. | ||
| Cardiovascular system | ||
| Diuretic monotherapy for heart failure | Suboptimal treatment | Consider ACE inhibitor |
| Verapamil or diltiazem in heart failure | Aggravation of heart failure | Stop drug |
| Non-selective beta-blocker (e.g. eye drops) in heart failure, asthma | Bradycardia; bronchospasm | Consider selective beta-blocker |
| Concurrent use of ACE inhibitor, potassium supplement, or potassium sparing diuretic | Hyperkalaemia | Check serum potassium |
| Concurrent use of diuretic or antihypertensive and NSAID | Fluid retention, reduced antihypertensive effect | Consider plain analgesic, e.g. paracetamol |
| Central nervous system | ||
| Concurrent use of multiple psychoactive drugs | Increased effect | Revise indication and regimen |
| Amitryptiline, doxepine | Strongly anticholinergic, excessive sedation | Consider SSRI |
| Long term use of antipsychotics for non-psychotic indications | Limited efficacy, cognitive deterioration, extrapyramidal and anticholinergic side effects | Stop drug |
| Concurrent use of antiparkinsonian agents and phenothiazine antipsychotics | Treatment of avoidable ADR | Revise regimen |
| Long acting benzodiazepines | Excessive sedation, cognitive deterioration | Stop drug |
| Benzodiazepine anxiolytic and benzodiazepine hypnotic concurrently | Pharmacological duplication, excessive sedation | Stop (one) drug |
| Alimemazine, promethazine | Strong anticholinergic and extrapyramidal side effects | Stop drug |
| Propoxyphene, pentazocine | Cardiotoxic, nephrotoxic, confusion, hallucinations | Consider other opioid analgesic |
| Miscellaneous | ||
| NSAID (e.g. indomethacin) | Confusion, gastrointestinal side effects | Consider e.g. paracetamol |
| Iron supplement and NSAID or antithrombotics | Treatment of avoidable ADR | Reconsider regimen |
| Nutritional supplements for iron deficiency anaemia | Ineffective treatment | Consider iron supplement |
| Vitamin C monotherapy for cystitis prophylaxis | Ineffective treatment | Consider oestrogen, metenamin |