This document discusses the use of second-generation antipsychotics (SGAs) like olanzapine, risperidone, and aripiprazole to treat behavioral and psychological symptoms of dementia (BPSD) in elderly patients. It notes risks such as adverse drug effects, exacerbating age-associated diseases, and drug interactions. A literature review found these 3 SGAs showed effectiveness against BPSD, but each also carried risks: olanzapine increased diabetes and cardiovascular risk; risperidone increased stroke risk; aripiprazole had limited data on risks. The document calls for more research on SGA risks in elderly, and updating guidelines to help doctors safely prescribe these drugs.

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

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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
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variation across u.s. nursing homes in antipsychotc prescribing rates. Archives of Internal
Medicine, 170(1), 89-95. doi: 10.1001/archinternmed.2009/469
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drug data for 2007-2008. NCHS data brief, no 42. Hyattsville, MD: National Center for
Health Statistics. 2010.
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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
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