Table 1

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 problemsClinical implicationsSuggestion 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 failureSuboptimal treatmentConsider ACE inhibitor
    Verapamil or diltiazem in heart failureAggravation of heart failureStop drug
    Non-selective beta-blocker (e.g. eye drops) in heart failure, asthmaBradycardia; bronchospasmConsider selective beta-blocker
    Concurrent use of ACE inhibitor, potassium supplement, or potassium sparing diureticHyperkalaemiaCheck serum potassium
    Concurrent use of diuretic or antihypertensive and NSAIDFluid retention, reduced antihypertensive effectConsider plain analgesic, e.g. paracetamol
Central nervous system
    Concurrent use of multiple psychoactive drugsIncreased effectRevise indication and regimen
    Amitryptiline, doxepineStrongly anticholinergic, excessive sedationConsider SSRI
    Long term use of antipsychotics for non-psychotic indicationsLimited efficacy, cognitive deterioration, extrapyramidal and anticholinergic side effectsStop drug
    Concurrent use of antiparkinsonian agents and phenothiazine antipsychoticsTreatment of avoidable ADRRevise regimen
    Long acting benzodiazepinesExcessive sedation, cognitive deteriorationStop drug
    Benzodiazepine anxiolytic and benzodiazepine hypnotic concurrentlyPharmacological duplication, excessive sedationStop (one) drug
    Alimemazine, promethazineStrong anticholinergic and extrapyramidal side effectsStop drug
    Propoxyphene, pentazocineCardiotoxic, nephrotoxic, confusion, hallucinationsConsider other opioid analgesic
    NSAID (e.g. indomethacin)Confusion, gastrointestinal side effectsConsider e.g. paracetamol
    Iron supplement and NSAID or antithromboticsTreatment of avoidable ADRReconsider regimen
    Nutritional supplements for iron deficiency anaemiaIneffective treatmentConsider iron supplement
    Vitamin C monotherapy for cystitis prophylaxisIneffective treatmentConsider oestrogen, metenamin