美国老年医学会老年人潜在不适当用药共识 Beers标准(2015版)解读

2016-06-09 北京协和医院老年医学科曾平 刘晓红 北京协和医院药剂科 闫雪莲 中国医学论坛报

比尔斯(Beers)标准是保障老年患者用药安全的有效工具之一,对医师及药师在选择药物方面具有重要指导意义。美国老年医学会(AGS)于2015年10月8日再次发布对Beers标准的更新。2015年修订版Beers标准增加了考虑到药物相互作用所致的潜在药物不良反应、老年人应该避免的联合用药表,根据肾功能调整药物剂量的内容。现解读如下。 新增内容 2015年更新版Beers标准考虑到药物相互作用带来

比尔斯(Beers)标准是保障老年患者用药安全的有效工具之一,对医师及药师在选择药物方面具有重要指导意义。美国老年医学会(AGS)于2015年10月8日再次发布对Beers标准的更新。2015年修订版Beers标准增加了考虑到药物相互作用所致的潜在药物不良反应、老年人应该避免的联合用药表,根据肾功能调整药物剂量的内容。现解读如下。

新增内容

2015年更新版Beers标准考虑到药物相互作用带来潜在的药物不良反应风险,增加了老年人应避免联合应用的药物(表1)。其中主要是警惕血管紧张素转换酶抑制剂(ACEI)类药物引起高钾血症,以及抗抑郁药物、抗精神病药物、苯二氮类药物所引起跌倒等高风险。

对于肾功能不全的老年患者,因其肾脏清除能力下降,药物蓄积可导致毒性增加,所以本次Beers标准在修订中提出需要根据肾功能调整剂量的药物(表2)。其中,肾功能通常用肌酐清除率(CrCl)指标代表。


表1 老年人应避免合用的药物


表2 需要根据肾功能调整剂量的药物

调整内容

在2015版Beers标准新增内容(表3)中,针对老年患者潜在不适当药物部分提出如下方面。①胺碘酮在房颤合并心衰或左心室肥厚的患者中可作为控制节律的一线用药;②质子泵抑制剂(PPI)可增加老年人艰难梭菌感染、骨质疏松及脆性骨折风险,如无需要长期应用PPI的强指征,PPI使用时间不要超过8周;③去氨加压素因其引起低钠血症的风险,建议避免用于治疗夜尿增多,应寻找更安全的替代疗法;④抗组胺药物美克洛嗪因可引起意识混乱、口干、便秘及其他抗胆碱能副作用,也被加入老年人避免使用的药物种类名单中。


表3 2015版Beers标准新增内容

关于老年人避免使用的药物方面:①佐匹克隆和扎来普隆因可引起中枢神经系统不良反应,被加入到罹患痴呆或认知损害的老年患者避免使用的药物表中;②有跌倒史的老年患者应慎用阿片类药物;③抗抑郁药阿莫达非尼和莫达非尼可引起老年人失眠,亦应慎用。

2015年修订版Beers标准中,因部分项目合并调整以及一些药物在美国撤市不再使用,遂删减了部分药物(表4)。


表4 2015版Beers标准删减药物

同时,新版Beers标准的编者指出,医疗系统应对老年人用药进行更加审慎、密切的监测,规范用药问题上报;并进一步加强对药物相关问题的宣教,增进患者及照护者在药物使用方面的参与及交流,从而降低老年人用药不良事件。

注:表格中英文缩写NSAID为非类固醇类抗炎药,INR为国际标准化比值。

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    2016-09-16 ylzr123

    点个赞!好文章有待学习探讨。

    0

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    2016-09-10 1e10c84am36(暂无匿称)

    好文章,百姓也能从中学到好多医学知识

    0

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    2017-01-08 仁者大医
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    2016-06-11 milkshark

    标准不错

    0

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    2016-06-11 milkshark

    值得应用

    0

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