AQHA MULTIPLE MEDICATION VIOLATION SYSTEM (MMVS) 1. The AQHA Multiple Medication Violations System (MMVS) sets forth penalties for trainers, owners and horses subject of positive drug tests, and, in particular, is designed to assess penalties against trainers, owners and horses subject of multiple positive drug tests. This system is for AQHA’s use only and is not intended to be a subst
Beers criteria.xlsABOUT THE BEERS CRITERIA
In 1991 gerontologist Dr. Mark H. Beers developed a list of potentially avoidable, high-risk medications to be avoided in the elderly, based on the literature and consensus from a panel of experts. This list was subsequently updated in 1997, 2001, and most recentlyin 2003. We have used a modified version of the Beers drugs, based on Saskatchewan's formulary. The chart includes alternatives that are safer, yet equally effective.
COMMENTS (Beers rationale)
Propoxyphene & combo products
Offers few analgesic advantages over acetaminophen, Acetaminophen, various NSAID'syet has the adverse effects of other narcotic drugs.
Of all available nonsteroidal anti-inflammatory drugs, this drug produces the most CNS adverse effects.
Because of its strong anticholinergic and sedation SSRIs (if treating depression), nortriptyline properties, amitriptyline is rarely the antidepressant or desipramine (alternative TCAs with less anticholinergic effects) or gabapentin (fortreating pain).
Because of its strong anticholinergic and sedation properties, doxepin is rarely the antidepressantchoice for elderly patients.
This benzodiazepine hypnotic has an extremely long half-life in elderly patients (often days), producingprolonged sedation and increasing the incidence of falls and fracture. Shorter acting benzodiazepines arepreferable.
Because of its increased sensitivity to benzodiazepines Try to slowly reduce dosage over time.
in elderly patients, smaller doses may be effective as greater than: lorazepam (3mg);
well as safer. Total daily doses should rarely exceed oxazepam (60mg); alprazolam (2
mg); temazepam (15mg); and
These drugs have a long half life in elderly patients Chlordiazepoxide (Librium)
(often several days), producing prolonged sedation diazepam (Valium), clorazepate
and increasing the risk of falls and fractures. Shorter acting benzodiazepines are preferred if a benzodiazepine is required.
Disopyramide (Norpace and
Of all antiarrhythmic drugs, this is the most potent negative inotrope and therefore may induce heart consult cardiology or internal medicine if failure in elderly patients. It is also strongly anticholinergic. Other antiarrhythmic drugs should beused.
Digoxin (Lanoxin) (should not
Decreased renal clearance may lead to increased risk Consider periodic digoxin serum levels to of toxic effects. In frail elderly, toxicity is also more likely with blood levels in upper therapeutic range.
patient ages (reduced renal clearance with age may necessitate periodic dosage reduction.) Methyldopa (Aldomet) and
May cause bradycardia and exacerbate depression methyldopa-hydrochlorothiazide
in elderly patients. Also greater risk of orthostatic comorbidities, but may include: thiazide diuretics, ACE inhibitors, calcium channelblockers, beta-blockers, or angiotensin receptor blockers.
It has prolonged half-life in elderly pataients and could Glyburide, glimepiride, gliclazide, or other cause prolonged hypoglycemia. Additionally it is the non-sulfonylurea oral hypoglycemic agents.
only oral hypoglycemic agent that causes SIADH INDICATOR
COMMENTS (Beers rationale)
GI antispasmodic drugs are highly anticholinergic and Dependent on clinical scenario - consult GI drugs: dicyclomine (Bentyl)
have uncertain effectiveness. These drugs should be propantheline (Pro-banthine)
avoided (especially for long-term use).
Al non prescription and many prescription Cetirizine (Reactine), fexofenadine (Al egra), hydroxyzine (Atarax)
antihistamines may have potent anticholinergic loratadine(Claritin), desloratadine(Aerius) properties. Non-anticholinergic antihistamines are preferred in elderly patients when treating allergic reactions.
All barbiturates (except
Are highly addictive and cause more adverse effects than most sedative or hypnotic drugs in elderly and 3) secobarbital sodium.
Not an effective oral analgesic in doses commonly disadvantages relative to other narcotic drugs.
Has been shown to be no better than aspirin in preventing clotting and may be considerably more toxic. Safer, more effective alternatives exist.
Daily Flouoxetine (Prozac)
Long half-life of drug and risk of producing excessive CNS stimulation, sleep disturbances, and increasing agitation,. Safer alternatives exist.
Causes more sedation and anticholinergic adverse Thioridazine (Mellaril)
Greater potential for CNS and extrapyramidal Depends on clinical scenario - high potency or alypical antipsychotics (haloperidol, risperidone, queliapine olanzapine) Mesoridazine (Serentil)
CNS and extrapyramidal adverse effects.
Short acting Nifedipine
Potential for hypotension and constipation. 5 & 10 Long acting nifedipine (Adalat XL), felodipine mg capsule (I.e. not sustained or extended release Clonidine (Catapres)
Potential for orthostatic hypotension and CNS adverse Dependent on clinical scenario and effects.
comorbidities, but may include: thiazide diurectic, ACE - inhibitors, calcium channelblockers, beta-blockers, or angiotensinreceptor blockers.
Cimetidine (Tagamet) H2 blocker
CNS adverse effects including confusion.
Ranitidine (zantac) or others (dose may need to be decreased if reduced renalfunction).
Thyroid (Desiccated thyroid)
Concerns about cardiac effects. Safer alternatives Estrogens only (oral)
Evidence of the carcinogenic (breast and endometrial cancer) potential of these agents and lack of cardioprotective effects in older women.
OGGETTO: Approvazione del Piano Urbanistico Attuativo di iniziativa privata, relativo all’A.I.U. C2/3 – via Caselle nella frazione di Piovega, ai sensi dell’art. 20 della L.R. 11/2004 Cede la parola al Sig. Sindaco che riferisce: con deliberazione n. 2652 del 27 aprile 1990, la Giunta Regionale del Veneto, approvava con modifiche d’ufficio la variante generale al Piano Regolatore Gen