Anticholinergic medicines - medication management, prescribing cascades, and deprescribing
Ivana Tadic1, Anita Elaine Weidmann2
1Institute of Pharmacy, Department of Clinical Pharmacy, Innsbruck University, Innsbruck, Austria. ivana.tadic@uibk.ac.at.
Abstract:
This comment aims to raise awareness of the problems encountered when using anticholinergic burden (ACB) tools for the assessment of inappropriate medications (PIM), concerns related to prescribing cascades, and the process of deprescribing in patients older than 65 years. The first published tool, BEERS criteria from 1991, interpreted the ACB as the single biggest iatrogenic problem in treating older patients. Numerous subsequent publications repeated this interpretation rather than using real-world data. By comparing three internationally validated PIM tools (AGS BEERs criteria; EU(7)-PIM; PIM), this comment highlights how their anticholinergic (ACh) medicines lists differ, lack specific details on the strength of the ACh effect while also not providing suitable alternative pharmacological approaches. In addition, this comment considers the recognized contribution of ACh medicines in prescribing cascades and resultant inappropriate polypharmacy concerns while also considering barriers to deprescribing in the face of lacking detailed clinical guidance.
More Related Videos
07:58Behavioral and Network Pharmacology-Based Analyses for the Traditional Mongolian Medicine Zadi-5 in a Rat Model of Depression
Published on: February 24, 2023
12:18A Machine Learning Approach to Design an Efficient Selective Screening of Mild Cognitive Impairment
Published on: January 11, 2020
Related Concept Videos
Cholinergic Antagonists: Therapeutic Uses
Respiratory Tract: Ipratropium, aclidinium, and tiotropium treat asthma, chronic bronchitis, and chronic obstructive pulmonary disease (COPD). They protect against bronchoconstriction caused by irritants like cigarette smoke, sulfur dioxide, and ozone. They also help reduce nasopharyngeal...
Indirect-Acting Cholinergic Agonists: Pharmacological Actions
At the neuromuscular junction, these agents work by inhibiting the breakdown of acetylcholine, allowing it to remain bound to the receptor and bind to nearby receptors. This process leads to repetitive firing of the endplate, causing muscle...
Drug Therapy
Antianxiety Medications
Cholinergic Antagonists: Pharmacokinetics
Parkinson's Disease: Treatment
Parkinson's Disease is primarily a result of the loss of dopaminergic neurons in the substantia nigra pars compacta. The cornerstone of...
Antidepressant Drugs: MAOIs and Other Agents
