Table 2.
Medications commonly given in perioperative care that should be avoided or used with caution in patients over 65 year of age
adapted from the 2019 American geriatric society Beers criteria [111] and Berger et al. [103]
| Medication or class of medication | Examples | Rationale for avoiding |
|---|---|---|
| First generation antihistamines | Diphenhydramine, Chlorpheniramine | Central anticholinergic effects |
| Phenothiazine-type antiemetics | Prochlorperazine, Promethazine | Central anticholinergic effects |
| Antispasmodics/anticholinergics | Atropine, Scopolamine | Central anticholinergic effects |
| Antipsychotics(first and second generation) | Haloperidol | Risk of cognitive impairment, delirium, neuroleptic malignant syndrome, tardive dyskinesia |
| Benzodiazepines | Midazolam, Diazepam, Temazepam | Risk of cognitive impairment, delirium |
| Benzodiazepine receptor agonist hypnotics “ Z drugs” | Zolpidem, Eszopiclone | Delirium, falls |
| Corticosteroids | Hydrocortisone, Methylprednisolone | Risk of cognitive impairment, delirium, psychosis |
| H2-receptor antagonists | Ranitidine | Risk of cognitive impairment, delirium |
| Metoclopramide | Extrapyramidal effects | |
| Pethidine/Meperidine | Neurotoxic effect |
H2, histamine 2 receptor.