Table 1:
Beers Criteria Potentially Inappropriate Medications Commonly Used in Anesthesia*
| Medication Class | Examples | Precautions | Rationale |
|---|---|---|---|
| Pain Medications |
NSAIDs Ketorolac (Toradol) Diclofenac Ibuprofen |
Avoid when GFR < 30 (i.e., CKD stage IV & V) or AKI, and use caution with repeated doses | Increased risk of GI bleeding and AKI (specifically for ketorolac) |
|
Gabapentinoids Gabapentin (Neurontin) Pregabalin (Lyrica) |
Reduce dose or avoid when GFR < 60 | Increased risk of over-sedation | |
| Meperidine (Demerol) | Avoid, especially in patients with CKD | Higher risk of neurotoxicity, including delirium, than other opioids | |
| Sedative Hypnotics |
Benzodiazepines Midazolam (Versed) Lorazepam (Ativan) |
Avoid, except for specific indications such as seizure or alcohol withdrawal | Increased risk of delirium, cognitive impairment, falls, and fractures |
| Anticholinergics |
Tricyclic Antidepressants Amitriptyline (Elavil) Nortriptyline (Pamelor) |
Avoid | Increased risk of over-sedation, central anticholinergic side effects, delirium, and orthostatic hypotension |
| Diphenhydramine (Benadryl) Hydroxyzine (Vistaril) Prochlorperazine (Compazine) Promethazine (Phenergan) Scopolamine |
Avoid | Increased risk of over-sedation or central anticholinergic side effects, including delirium | |
| Antipsychotics | Haloperidol (Haldol) Olanzapine (Zyprexa) |
Avoid, except for in use in psychiatric disease or as short-term antiemetic | Increased risk of stroke and cognitive decline in dementia |
| Antidopaminergics | Haloperidol (Haldol) Metoclopramide (Reglan) Prochlorperazine (Compazine) Promethazine (Phenergan) |
Avoid in patients with Parkinsonian disorders | Increased risk of extrapyramidal side effects and delirium |
| Steroids | Dexamethasone (Decadron) | Avoid or use cautiously | Increased risk of delirium |
Abbreviations: NSAIDs, non-steroidal anti-inflammatory drugs; GFR, glomerular filtration rate; CKD, chronic kidney disease; AKI, acute kidney injury; GI, gastrointestinal; ESRD, end-stage renal disease
*
Adapted from AGS 2019 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults [18]