1. Caitlyn Cardetti
Advisor: Dr. Dawn Albertson

2. • Fastest growing age group.
• Often excluded from clinical trials.
• Most likely age group to use
prescription drugs.
1 2 3-4 5+
Number of Prescription Drugs
Risk of Polypharmacy with Age
Ages 20-59 Age 60+

4. • Symptoms include but are not limited to:
• Agitation
• Irritability
• Anxiety
• Commonly treated with off label use of second
generation antipsychotics (SGA)
• FGA vs. SGA

5. • 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

6. • 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 in
with the following categories:
• Adverse Drug Effects (ADE)
• Age-Associated Diseases
• Polypharmacy

7. • 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

8. • 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
1
14%
2
14%
3-4
31%
5+
41%
Polypharmacy in those Age
60+

9. • Increase resources available for doctors when
prescribing
• Need for further studies in exacerbation of age-associated
diseases and drug interactions
Olanzapine Risperidone Aripiprazole
Donezepil
- ? ?
Antidiuretic
s
? ? ?
Beta
Blockers
- ? ?
Statins
- - -
Olanzapine Risperidone Aripiprazole
CV Disease
+ - -/?
Diabetes
- - ?

10. • Update the Beers Criteria

11. • Update the Beers Criteria

12. • 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

13. • Cerejeira, J., Largarto, L., & Mukaetova-Ladinska, E. B. (2012). Behavioral and
psychological symptoms of dementia. Frontiers of Neurology, 3(73), doi:
10.3389/fneur.2012.00073.
• Maher, A., Maglione, M., Bagley, S., Suttorp, M., Hu, J., Ewing, B., Wang, Z., Timmer, M., &
Shekelle, P.G. (2011). Efficacy and comparative effectiveness of atypical antipsychotic
medications for off-label uses in adults: A systematic review and meta-analysis. Journal of
American Medical Association, 306(12), 1359-69. Retrieved from
http://www.ncbi.nlm.nih.gov.ezproxy.mnsu.edu/pubmed/21954480
• Department of Health and Human Services, Administration of Aging. (2011). Aging statistics.
Retrieved from website: http://www.aoa.gov/AoARoot/Aging_Statistics/index.aspx
• Chen, Y., Briesacher, B., Field, T., Tjia, J., Lau, D., & Gurwitz, J. (2011). Unexplained
variation across u.s. nursing homes in antipsychotc prescribing rates. Archives of Internal
Medicine, 170(1), 89-95. doi: 10.1001/archinternmed.2009/469
• Gu Q, Dillon CF, Burt VL. Prescription drug use continues to increase: U.S. prescription
drug data for 2007-2008. NCHS data brief, no 42. Hyattsville, MD: National Center for
Health Statistics. 2010.
• Agency for Healthcare Research and Quality, Effective Health Care Program. (2011). Off-
label use of atypical antipsychotics: An update. comparative effectiveness review no.
43 (Publication No. 11-EHC087-EF). Retrieved from AHRQ Publication website:
http://www.effectivehealthcare.ahrq.gov/search-for-guides-reviews-and-
reports/?pageaction=displayproduct&productid=786
• Jeste M.D., D., Dolder, Pharm.D., C., Nayak M.A., G., & Salzman M.D., C. (2005). Atypical
antipsychotics in elderly patients with dementia or schizophrenia: Review of recent
literature. Harvard Review of Psychiatry, 13, 340-351. doi: 10.1080|10673220500433247

14. • (2012). American geriatrics society updated beers criteria for potentially inappropriate
medication use in older adults. Journal of American Geriatrics Society, doi: 10.1111/j.1532-
5415/2012.03923/x
• De Deyn, P., Katz, I., Brodaty, H., Lyons, B., Greenspan, A., & Burns, A. (2005).
Management of agitation, aggression, and psychosis associated with dementia: A pooled
analysis including three randomized, placebo-controlled double-blind trials in nursing home
residents treated with risperidone. Journal of Clinical Neurology and Neurosurgery, doi:
10.1016/j/clineuro.2005.03.013
• McShane, R., Keene, J., Gedling, K., Fairburn, C., Jacoby, R., & Hope, T. (1997). Do
neuroleptic drugs hasten cognitive decline in dementia? Prospective study with necropsy
follow up. British Medical Journal,315(7076), 266-270. Retrieved from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2125727/
• Ballard C, Lana MM, Theodoulou M, Douglas S, McShane R, et al. (2008) A
Randomised, Blinded, Placebo-Controlled Trial in Dementia Patients Continuing or Stopping
Neuroleptics (The DART-AD Trial) . PLoS
Med 5(4): e76. doi:10.1371/journal.pmed.0050076Strait, J. B., & Lakatta, E. G. (2012).
Aging-associated cardiovascular changes and their relationship to heart failure. Heart
Failure Clinics, 8(1), 143-164. doi: 0.1016/j.hfc.2011.08.01
• Glassman, A., & Bigger Jr., J. (2001). Antipsychotic drugs: prolonged qtc interval, torsade de
pointes, and sudden dath . American Journal of Psychiatry,158(11), 1774-82. Retrieved
from http://www.ncbi.nlm.nih.gov/pubmed/11691681
• Lindborg, S., Beasley, C., Alaka, K., & Taylor, C. (2003). Effects of intramsucular olaznapine
vs. haloperiodol and placebo on qtc intervals in acutely agitated patients. Psychiatry
Research Journal, 119(1-2), 113-23. Retrieved from
http://www.ncbi.nlm.nih.gov/pubmed/12860365

15. • Gulisano, M., Cali, P., Cavanna, A., Eddy, C., Rickards, H., & Rizzo, R. (2011).
Cardiovascular safety of aripiprazole and pimozide in young patients with tourette
snydrome. Journal of Neurological Sciences, 32(6), 1213-7. Retrieved from
http://www.ncbi.nlm.nih.gov/pubmed/21732066
• tminan, M., Streiner, D., & Ronchon, P. (2003). Exploring the association between atypical
neuroleptic agents and diabetes mellitus in older adults.Pharmacotherapy, 23(11), 1411-5.
Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/14620387
• Kroner Pharm.D., B.C.P.S., B. (2002). Common drug pathways and interactions. Diabetes
Spectrum, 15(4), 249-255. doi: 10.2337/diaspect.15.4.249
• Nirogi, R., Bjyrapuneni, G., Kandikere, V., Benade, V., Muddana, N., Saralaya, R., Irappana
var, S., Ponnamaneni, R., & Mukkanti, K. (2012). Concurrent administration of atypical
antipsychotics and donepezil: drug interaction study in rats. European Journal of Drug
Metabolism and Pharmacokinetics, Retrieved from
http://www.ncbi.nlm.nih.gov.ezproxy.mnsu.edu/pubmed/22302541
• van den Heuvel, O., Bet, P., van Dam, E., & Eeckhout, A. (2006). The syndrome of
inappropriate antidiuretic hormone secretion (siadh) during treatment with the antipsychotic
agents haloperidol and quetiapine.Ned Tijdschr Geneeskd, 150(35), 1944-8. Retrieved from
http://www.ncbi.nlm.nih.gov/pubmed/16999280
• Atalay, A., Turnhan, N., & Aki, O. (2007). A challenging case of syndrome of inappropriate
secretion of antidiuretic hormone in an elderly patient secondary to quetiapine. Southern
Medical Journal, 100(8), 832-3. Retrieved from
http://www.ncbi.nlm.nih.gov/pubmed/17713312

16. • Webber, M., Mahmud, W., Lightfoot, J., & Shekhar, A. (2004). Rhabdomyolysis and
compartment syndrome with coadministration of risperidone and simvastatin. Journal of
Psychopharmacology,18(3), 432-4. Retrieved from
http://www.ncbi.nlm.nih.gov/pubmed/15358990
• Patier, J., Ferrere, F., Moreno-Cobo, M., & Echaniz, A. (2007). Rhabdomyolysis caused by
association of simvastatin and risperidone. Medicina clinica ,129(11), 439. Retrieved from
http://www.ncbi.nlm.nih.gov/pubmed/17927942
• Vivves, S., Batlle, M., Motane, E., & Ribera, J. (2008). Rhabdomyolysis and renal failure
secondary to interaction between simvastatin, ciclosporin a and risperidone in an allogeneic
stem cell transplantation patient. Medicina clinica , 131(17), 676. Retrieved from
http://www.ncbi.nlm.nih.gov/pubmed/19087798
• Walder, A., & Baumann, P. (2009). Mood stabilizer therapy and pravastatin: higher risk for
adverse skin reactions?. Acta Medica, 52(1), 15-18. Retrieved from
http://www.ncbi.nlm.nih.gov/pubmed/19754002
• Ohaski, K., Hamamura, T., Lee, Y., Fujiwara, Y., Suzuki, H., & Kuroda, S. (2000). Clozapine-
and olanzapine-induced fos exression in the rat medial prefrontal cortex is mediated by
beta-adrenoceptors. Neuropsychopharmacology,23(2), 162-9. Retrieved from
http://www.ncbi.nlm.nih.gov/pubmed/10882842