need for higher regulation of sga prescribing for bpsd
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Need for Higher Regulation of Second Generation
Antipsychotics Prescribing for Behavioral & Psychological
Symptoms of DementiaCaitlyn Cardetti
Advisor: Dr. Dawn Albertson
The Elderly• Fastest growing age group.• Often excluded from clinical trials.• Most likely age group to use
prescription drugs.
1 2 3-4 5+
Risk of Polypharmacy with AgeAges 20-59 Age 60+
Number of Prescription Drugs
The Aging Body & Drugs
Behavioral & Psychological Symptoms of Dementia (BPSD)
• Symptoms include but are not limited to:• Agitation• Irritability• Anxiety
• Commonly treated with off label use of second generation antipsychotics (SGA)• FGA vs. SGA
Purpose• Identify appropriateness of SGA as treatment for BPSD• Efficacy• Possible Adverse Drug Effects (ADE)
• Specific issues concerning the elderly• Exacerbation of Age-Associated Diseases• Drug Interactions
Methodology• Use of broad search terms in PubMed database• Preliminary search found only 3 of 9 SGA to be
effective for treatment of BPSD• Olanzapine• Risperidone• Aripiprazole
• Each drug individually searched inwith the following categories:• Adverse Drug Effects (ADE)• Age-Associated Diseases• Polypharmacy
Exacerbation of Age-Associated Diseases• Cardiovascular Disease• Olanzapine – favorable QTc profile• Risperidone – increased risk of stroke, possible risk of QT
prolongation• Aripiprazole – possible risk of QT prolongation
• Diabetes• Olanzapine – associated with increased glucose levels• Risperidone – associated with a few cases of
hyperglycemia• Aripiprazole – no data
Drug Interactions• Donezepil (Aricept)• Treatment for mild to moderate Alzheimer’s Disease• Possible indication of increased movement disorders with
olanzapine
• Antidiuretics• Drugs that limit formation of urine• No literature available
• Beta Blockers• Drugs commonly prescribed for HTN• Olanzapine is inhibited by a common beta blocker
• Statins• Medication that lowers cholesterol• Possible increased risk of muscle breakdown
when used with SGA
114%
214%
3-431%
5+42%
Polypharmacy in those Age 60+
Conclusion & Recommendations• Increase resources available for doctors when
prescribing• Need for further studies in exacerbation of age-associated
diseases and drug interactions
Olanzapine
Risperidone
Aripiprazole
Donezepil - ? ?Antidiuretics
? ? ?Beta Blockers
- ? ?Statins - - -
Olanzapine
Risperidone
Aripiprazole
CV Disease
+ - -/?Diabetes - - ?
Conclusions & Recommendations• Update the Beers Criteria
Conclusions & Recommendations• Update the Beers Criteria
Conclusions & Recommendations• Create standard guidelines for prescribing• Assurance that non-pharmacological interventions were
tried but failed• Evaluations for drug profiles based on patient’s current
health condition• Recommendations for follow-ups
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