Anticholinergic Side Effects Research Articles

Management of overactive bladder: consensus statements from the Hong Kong Urological Association and the Hong Kong Geriatrics Society.

Overactive bladder (OAB) is a common urological disease with a high prevalence in older adult populations. Antimuscarinic drugs have been the most common treatment for OAB for more than a decade, but their anticholinergic side-effects and potential impact on cognitive function among older patients are usually underestimated. This consensus aimed to provide practical recommendations concerning OAB management, with a particular emphasis on older patients. A joint consensus panel was formed by representatives of the Hong Kong Urological Association and the Hong Kong Geriatrics Society. Literature searches regarding OAB and its management were performed in PubMed and Ovid. Several working meetings were held to present and discuss available evidence, develop consensus statements, and vote for the statements. A modified Delphi method was used in this consensus process. To address questions regarding various aspects of OAB, 29 consensus statements were proposed covering the following areas: diagnosis, initial assessment, non-pharmacological treatments, considerations before administration of pharmacological treatments, various pharmacological treatments, combination therapy, and surgical treatment. Twenty-five consensus statements were accepted.

2336 Prevalence of anticholinergic burden across a cohort of frail older adults in a district general Hospital in South West Wales

Abstract Background and Objectives Polypharmacy is common in frail older adults who often live with multiple co-morbidities. This polypharmacy can carry a significant anticholinergic burden. Frail older adults are particularly sensitive to the anticholinergic side effects of medications which can include constipation, urinary retention and dry mouth. Medications with a high anticholinergic burden scores have also been evidenced to contribute to an increased frequency of falls, cognitive decline and increased mortality. For frail older adults, a medication review, considering anticholinergic burden, is therefore an essential part of Comprehensive Geriatric Assessment. A local frailty census was completed for all medical inpatients over the age of 65 years old and as part of this anticholinergic burden scores were collated. Materials and Methods As part of this whole hospital frailty census, an anticholinergic burden score (ACB) was calculated for 77 inpatients. This was calculated using the Anticholinergic Cognitive Burden Scales and Anticholinergic Burden scores. Results The average age of the patients was 80.19 (± 9.35). 80.01% of patients were taking one or more medications with an anticholinergic burden. Of those, 40.25% had a significant ACB score of 3 or more (3–8). The patients with the highest ACB scores were those with multi-morbidity, an already established diagnosis of dementia and patients with recurrent falls. Conclusions The ACB score for patients included within this frailty census appeared to correlate with certain co-morbidities as would be expected from the known complications associated with these medications in frail older adults. The proportion of our inpatients with a significant ACB score informs us that we need to develop a more robust approach to delivering polypharmacy reviews as part of Comprehensive Geriatric Assessment within our hospital and will help us to inform future service planning and delivery.

Identification of Psychoplastogenic Tropanes Lacking Muscarinic Activity.

Tropane-containing small molecules like scopolamine are a promising class of psychoplastogens. However, their potent antagonism of all muscarinic receptor subtypes presents the potential for undesirable anticholinergic side effects. In an effort to decouple their neuroplasticity-promoting effects from their muscarinic activity, we performed phenotypic structure-activity relationship studies across a variety of structurally distinct subclasses of tropanes. We discovered several novel tropanes capable of significantly increasing cortical neuronal growth while exhibiting drastically reduced activity at all muscarinic receptor subtypes compared to scopolamine.

Anticholinerge lading bij oudere volwassenen in een woonzorgcentrum: een pilootonderzoek

Older adults are more at risk for side effects from medications. Mainly anticholinergic side effects can lead to central and peripheral side effects on somatic and cognitive levels. In this study, we determined the anticholinergic load of the medication regimens of residents of a residential care center using two validated measurement scales. We also examined to which extent the class(es) of medications influence this anticholinergic load. Finally, we analyzed the association of a high anticholinergic load with incidents (urinary tract infections, falls, delirium). In this pilot study we see a high degree of polymedication and use of psychotropic drugs with an anticholinergic effect. On average we established a score of 1.67 on the ACB and a score of 0.87 on the DBI. The anticholinergic load in the ACB is mainly determined by antipsychotics (t = 6.110, p < 0.001), in the DBI an influence of all medications with anticholinergic properties is seen (F = 6.764, p < 0.001). A risk score on the DBI has a statistically significant correlation with experiencing a urinary tract infection (F = 5.877, p = 0.018). This influence remains significant after adjusting for covariates. The anticholinergic load of medication regimens in residents is high. An increased anticholinergic load is also associated with urinary tract infection. Reducing the anticholinergic load within residential care centers therefore represents an important challenge for the future.

The relationship between salivary flow rate, oral health, and malnutrition in the elderly: a cross-sectional study “about”

I would like to write regarding the article titled "The relationship between salivary flow rate, oral health, and malnutrition in the elderly: a cross-sectional study," published in the Pamukkale Medical Journal. The authors have conducted a study that involved considerable effort, and as a geriatrician, I extend my gratitude to them for their valuable contribution to this significant area of geriatrics. The relationship between salivary flow rate, oral/dental health, and the presence of malnutrition in older adults had been evaluated in this study. The study excluded individuals with diseases that could affect salivary flow rate and those who received radiotherapy to the head and neck region. However, the comorbidities or medications of the individuals were not inquired about or recorded. This was an important concern for me because the use of drugs with anticholinergic side effects could potentially affect salivary flow rates. n this letter, I aimed to highlight the impact of medications with anticholinergic effects on salivary glands and suggest alternative study designs for future research.

Intravenous Cetirizine Premedication to Mitigate Infusion-Related Reactions.

Infusion-related reactions (IRRs) are a recognized concern for chemotherapy, biologic agents, and newer immunotherapies. Antihistamines are frequently recommended to prevent or manage these reactions. For over 60 years, diphenhydramine has been the only H1 antihistamine for intravenous (IV) administration. It has been considered the standard of care as part of premedication regimens to prevent IRRs associated with these therapies despite the lack of a US Food and Drug Administration (FDA)-approved indication and no evidence of efficacy data. Intravenous cetirizine was approved in 2019 for acute urticaria treatment, making it the only second-generation H1 antihistamine that can be administered intravenously. Compared with diphenhydramine, cetirizine has an improved safety profile with less sedation, fewer contraindications, lower incidence of anticholinergic side effects, and minimal risk of adverse events in elderly patients. A head-to-head study demonstrated that IV cetirizine is as effective as IV diphenhydramine in reducing IRRs and may decrease chair time, treatment center visits, and the need for rescue medication. Over the past 3 decades, the FDA has addressed the issue of IRRs by mandating language regarding the requirement or recommendation for premedication in the label of over 50 FDA-approved infusion products. As more therapeutics have premedication required or recommended, IV cetirizine should be considered an antihistamine for preventing and treating IRRs. In this article, we describe a patient whose IRR was successfully managed with IV cetirizine and discuss first- vs. second-generation H1 antihistamines and their use in treating and preventing IRRs.

Common Drugs Causing Xerostomia

Saliva is need for maintaining a healthy mouth environment and general health.Many factors can affect the volume and compositions of saliva. Xerostoma which refers to a subjective sensation of dry mouth, is derived from the Greek words "xeros" (ξηρός), which means "dry," and "stoma" (στόμα), which means "mouth." Reduced salivary flow and altered salivary gland composition and function are the outcomes of xerostomia.Symptoms of xerstomia include dryness or a feeling of stickiness in your mouth. Saliva that seems thick and stringy, bad breath and having hard time chewing, speaking and swallowing. There are many different causes of xerostomia, which include medicine, aging, cancer therapy, nerve damage and tabaco and alcohol use. The most common drugs causing xerstomia anticholinergic drugs, antidepressant drugs, diuretics, calcium channel blocker and beta-blockers. Different mechanism of causing xerostomia cytotoxic drugs by direct damage to salivary gland, antidepressant drugs by their anticholinergic side effects, and diuretic by excreting more fluid and electrolytes.

Comparative analysis of anticholinergic burden scales to explain iatrogenic cognitive impairment and self-reported side effects in the euthymic phase of bipolar disorders: Results from the FACE-BD cohort

Bipolar disorders (BD) are characterized by cognitive impairment during the euthymic phase, to which treatments can contribute. The anticholinergic properties of medications, i.e., the ability of a treatment to inhibit cholinergic receptors, are associated with cognitive impairment in elderly patients and people with schizophrenia but this association has not been well characterized in individuals with remitted BD. Moreover, the validity of only one anticholinergic burden scale designed to assess the anticholinergic load of medications has been tested in BD. In a literature review, we identified 31 existing scales. We first measured the associations between 27 out of the 31 scales and objective cognitive impairment in bivariable regressions. We then adjusted the bivariable models with covariates: the scales significantly associated with cognitive impairment in bivariable and multiple logistic regressions were defined as having good concurrent validity to assess cognitive impairment. In a sample of 2,031 individuals with euthymic BD evaluated with a neuropsychological battery, two scales had good concurrent validity to assess cognitive impairment, whereas chlorpromazine equivalents, lorazepam equivalents, the number of antipsychotics, or the number of treatments had not. Finally, similar analyses with subjective anticholinergic side-effects as outcome variables reported 14 scales with good concurrent validity to assess self-reported peripheral anticholinergic side-effects and 13 to assess self-reported central anticholinergic side-effects. Thus, we identified valid scales to monitor the anticholinergic burden in BD, which may be useful in estimating iatrogenic cognitive impairment in studies investigating cognition in BD.

Hyoscine hydrobromide patches: risk of anticholinergic side effects

Hyoscine hydrobromide patches: risk of anticholinergic side effects

Comparative Safety Profiles of Individual Second-Generation H1-Antihistamines for the Treatment of Chronic Urticaria: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials.

The comparative safety and/or dosing regimens of individual second-generation H1-antihistamines (sgAHs) in patients with chronic urticaria (CU) remain poorly elucidated. To compare the safety profiles of individual sgAHs and/or dosing regimens in adolescents or adult patients with CU using a systematic review and network meta-analysis of all available evidence. With limited English publications, electronic databases and gray literature were searched for randomized clinical trials from inception, with searches last updated on January 20, 2023. Relevant safety outcomes included treatment unacceptability (all-cause discontinuation), tolerability (discontinuation due to any adverse events), adverse events, serious adverse events, central nervous system (CNS) side effects, and anticholinergic side effects. Regarding the network estimates, the probability of being associated with the highest adverse outcome risk was estimated for each treatment comparison. Fifty-one randomized clinical trials with 14 individual sgAHs and different dosing regimens, involving 7502 participants, were included. On the basis of the findings from network meta-analyses, variations in sgAH treatment comparisons were observed regarding the unacceptability of treatment, tolerability, adverse events, and CNS side effects. There were no statistically significant differences between the results of sgAH treatment for serious adverse events and those for anticholinergic side effects. On the basis of the ranking of safety profiles, emedastine 4 mg, mizolastine 10 mg, and cetirizine 10 mg were the top 3 ranked treatments with unfavorable safety profiles associated with CNS side effects and any adverse events. These findings suggest evidence of variations in safety profiles among sgAHs for CU treatment, particularly in terms of adverse events and CNS side effects.

Clozapine use at a specialised psychiatric hospital in Johannesburg.

Clozapine is the gold standard medication for treatment-resistant psychosis, with robust evidence supporting its efficacy in multiple symptom domains. However, clozapine's side effect profile contributes to its underutilisation and discontinuation. This study aimed to explore the magnitude of clozapine use and describe factors that impact on its effective use among in-patients. Tara Hospital, a specialised psychiatric hospital in Johannesburg. This was a retrospective, cross-sectional file review of clozapine-treated patients admitted over the 2-year study period. Data variables included: demographics, clinical information, discharge prescription, clozapine-related side effects and details of clozapine discontinuation, where applicable. A cohort of 33.2% of patients from Tara's biological wards received a trial of clozapine. Participants experienced anti-cholinergic clozapine-related side effects that included weight gain (79.5%), tachycardia (35.2%) and constipation (35.2%). Clozapine was discontinued in 13.7% of participants, and no life-threatening side effects or deaths occurred. Significantly more use of flupenthixol decanoate (64.3% vs. 30.7%; p = 0.0322) and anticholinergics (35.7% vs. 11.4%; p = 0.0474) occurred in the clozapine-discontinued group. Polypharmacy rates were high for psychiatric and non-psychiatric medications. One-third of patients received clozapine trials, most of whom continued at discharge. Although side effects occurred frequently, life-threatening side effects did not. Clozapine monitoring protocols, side effect rating scales, pre-emptive management of side effects, lifestyle interventions and clinician education may improve outcomes of clozapine use. The use of plasma clozapine levels may be beneficial. This study expands our limited knowledge regarding current clozapine prescribing trends in South Africa.

681 Postoperative Muscle Relaxant Use Associated With Increased Risk of Delirium Following Lumbar Spinal Fusion

INTRODUCTION: Muscle relaxants including cyclobenzaprine and baclofen are frequently utilized in pain management following spine surgery as part of enhanced recovery after surgery (ERAS) protocols. These medications are associated with anticholinergic and central nervous system side effects and are used with caution in outpatient treatment for those at high-risk of delirium, especially the elderly. Literature investigating their association with delirium in the postoperative setting has not been described. METHODS: Patients over age 65 undergoing elective posterior lumbar fusion between 2017 and 2021 at the senior author’s institution were retrospectively reviewed. Variables collected included patient demographics as well as whether subjects received postoperative administration of baclofen and/or cyclobenzaprine on postoperative day 1 as part of a multimodal analgesia regimen. Doubly-robust inverse probability weighting (IPW) with cox-regression was used to evaluate the incidence of postoperative delirium between groups. RESULTS: Five-hundred and thirty-one patients were included in the analysis. Incidence of delirium in those who received postoperative muscle relaxants was 17.6% (44/250) compared to 11.4% (32/281) in the control group who did not (p = 0.001). Doubly-robust IPW analysis found patients who received muscle relaxants were at a 2.07 (95% CI: 1.18-3.63) times increased risk of delirium compared to controls (p = 0.015). Postoperative time to delirium onset was similar between groups (3.0 vs 3.1 days; p = 0.916) while the average duration of delirium was significantly longer in those who received postoperative muscle relaxants (2.5 vs 1.6 days; p = 0.008). CONCLUSIONS: Postoperative muscle relaxant use was associated with a higher risk of delirium in elderly adults following lumbar spinal fusion. Although muscle relaxants may assist with postoperative pain control as part of ERAS protocols while minimizing opioid administration, their side effect profile should be considered in patients at high risk of postoperative delirium.

Anticholinergic Medication and Caries Status Predict Xerostomia under 65.

The use of anticholinergic medications is increasing in younger ages, yet information about xerostomia, the most common anticholinergic side effect, is limited. This case-control retrospective study examines the relationship between anticholinergic medication-induced xerostomia and caries status among adults between 18 and 65 years of age. The study sample comprised 649 cases with xerostomia and 649 age- and gender-matched controls. The anticholinergic burden was estimated using the anticholinergic drug scale (ADS). Caries experience was recorded by calculating the Decayed, Missing, Filled Tooth (DMFT) index. Individuals with xerostomia had a higher mean DMFT index (16.02 ± 9.50), which corresponded with a higher level of anticholinergic exposure from medications (3.26 ± 2.81) compared to their age and gender-matched controls without xerostomia (13.83 + 8.83 and 1.89 ± 2.45, respectively). Logistic regression analysis verified the effects of DMFT, the total number of AC medications, and the ADS burden on xerostomia status. Comparing adults with or without xerostomia revealed statistical differences in several risk factors, such as smoking, diabetes, sleep apnea, and the utilization of anticholinergic medications. A personalized dental care plan should include the evaluation of the anticholinergic burden from medications regardless of the patient's age to prevent increased caries severity.

Schizophrenia and myasthenia gravis: a case report

IntroductionDespite a variety of pharmacological and psychotherapeutic interventions, treatment of schizophrenia can still be challenging, even more when certain comorbidities are present. Myasthenia gravis (MG) is an autoimmune disorder of the neuromuscular junctions caused by antibodies against acetylcholine and tyrosine kinase. While co-occurrence of schizophrenia and MG is rare, treatment can be complicated as specific treatment of one condition can lead to worsening of other (e.g. anticholinergic side effects of psychopharmacotherapy, psychiatric side effects of corticosteroids).ObjectivesTo discuss treatment difficulties in the case of a patient with schizophrenia and multiple somatic comorbidities, including MG.MethodsA case report and a review of literature.ResultsWe report a case of a 50-year-old female patient who was admitted to psychiatric hospital due to psychotic decompensation presented with dysphoria, paranoid delusions, agitation, verbal aggression and hostility. Clinical presentation and psychopharmacological treatment were complicated with her comorbid disorders, MG, which was recently treated because of a relapse, and hypothyroidism, which worsened as she neglected her regular check-ups. Multidisciplinary approach was needed to control the symptoms of her comorbid disorders, which, especially MG, limited psychopharmacological options. Combination of antipsychotics (aripiprazole, haloperidol) and mood stabilizer (sodium valproate) led to clinical improvement of psychotic symptoms. However, poor insight remained- the patient insisted on demission and was not interested in suggested psychotherapeutic and sociotherapeutic programs.ConclusionsIn complex cases like this, multidisciplinary approach is essential for adequate treatment of both psychiatric and comorbid somatic disorders. Conditions like MS can prolong treatment or even worsen the symptoms of a psychiatric disorder, especially since they limit the use of psychopharmacotherapy. Due to this, psychotherapeutic interventions could be even more important to keep a stable remission with a good insight and adherence to both psychiatric and somatic treatment.Disclosure of InterestNone Declared

Anticholinergic Medications and Parent-Reported Anticholinergic Symptoms in Neurologically Impaired Children.

Children with severe neurological impairment and polypharmacy are exposed to anticholinergic (AC) medications that may have anticholinergic side effects, but this is understudied. Anticholinergic Cognitive Burden (ACB) scores measure total anticholinergic burden for a medication regimen, and scores ≥3 have been associated with increased morbidity and mortality in adults. We assessed the relationship between ACB scores and parent-reported anticholinergic symptoms in children. Cross-sectional study of patients one to 18 years-old with ICD-defined severe neurological impairment and polypharmacy. At routine clinical visits, total ACB scores were computed for all medications. Parent-reported AC symptoms (constipation, drowsiness, difficulty concentrating, dry mouth, or urinary problems) were assessed. Multivariable logistic regression was used to test the association between total ACB scores ≥3 for scheduled medications and the presence of AC symptoms, adjusted for age and recent acute healthcare utilization. Among 123 unique patients, 87% were prescribed AC medications. Common AC medication classes included: systemic antihistamines (64%), anxiolytics (53%), antidepressants (30%), H2 blockers (22%), and muscle relaxants (20%). Total ACB scores ≥3 were observed in 44% for scheduled medications and in 63% of patients for scheduled plus PRN medications. Total ACB scores ≥3 were significantly associated with an increased odds of ≥1 anticholinergic symptoms for scheduled medications (OR: 3.1; 95% CI: 1.4, 6.7) and for scheduled plus PRN medications (OR: 2.9; 95% CI: 1.3, 6.4). If replicated in larger populations, the association between elevated total ACB scores and anticholinergic side effects in children should prompt clinicians to consider deprescribing potentially unneeded anticholinergic medications.

Mechanistic insights into the role of plant polyphenols and their nano-formulations in the management of depression.

Depression is a condition characterized by low mood and an aversion to activity, that causes behavioral problems, poor quality of life and limits daily life activities. It is considered as the fourth leading cause of disability worldwide. Selective Serotonin Reuptake Inhibitors (SSRIs) Monoamine Oxidase (MAO) inhibitors, Tricyclic Antidepressants (TCAs), and atypical antidepressants are some of the conventional medications used to treat depression. However, only about half of patients with major depressive disorder (MDD) respond effectively to first-line antidepressant therapy. Additionally, there are a number of drawbacks to standard antidepressants, such as anti-cholinergic side effects, drug-drug interactions, and food-drug interactions, which prompts researchers to look at alternative approaches to the treatment of depression. Medicinal plants and their metabolites are extensively tested for their efficacy against depression. Electronic databases such as Google scholar, Science Direct, SciFinder and PubMed were used to search relevant literature on the role of polyphenols in depression. Plants-derived Polyphenols represent a major class of compounds extensively distributed in plants. Number of polyphenols have demonstrated antidepressant activity, among which berberine, piperine, curcumin, naringenin, ascorbic acid and ginsenosides are extensively evaluated. The medicinal plants and their derived compounds mediated synthesized green nanoparticles have also exhibited considerable efficacy in the management of depression. The therapeutic effects of these phytochemicals is mediated via differentiation and inhibition of neuronal cell apoptosis, promotion of neuronal cell survival and modulation of key neurotransmitters. The aim of this study is to review compressively the chemical, pharmacological and neurological evidence showing the potential of polyphenols in depression.

Study on Antidepressant Emotion Regulation Based on Feedback Analysis of Music Therapy with Brain-Computer Interface.

In today's society, people with poor mental ability are prone to neuropsychiatric diseases such as anxiety, ADHD, and depression due to long-term negative emotions. Although conventional Western medicine has certain curative effect, these drugs have significant anticholinergic side effects central toxicity as well as cardiovascular and gastrointestinal side effects which limit their application in the elderly. At present, several antidepressants used in clinic have certain limitations. According to the symptoms of depression, this paper proposes a feedback emotion regulation method of brain-computer interface music therapy. This method uses special music stimulation to regulate the release of inhibiting sex hormones in the body, reduce the influence of negative emotions on the internal environment of the body, and maintain the steady state of the body. In this method, EEG is used as the emotional control signal of depressed patients, and this biological signal is transformed into music that depressed patients can understand, so as to clarify their physiological and psychological state and realize emotional self-regulation by feedback.

Safety and tolerability of solifenacin in children and adolescents with overactive bladder- a systematic review

Solifenacin is an anticholinergic that is used to treat overactive bladder syndrome (OAB) in children. It is important to ascertain the safety and tolerability of solifenacin in the paediatric population as solifenacin offers an alternative, is more bladder specific, and should have less anticholinergic side effects than other therapies. The aim of this study is to systematically evaluate the safety and tolerability of solifenacin in children and adolescents with OAB. We included studies that reported the safety and tolerability of solifenacin in children and adolescents. All study types were included. Electronic searches were conducted in Ovid MEDLINE, Ovid Embase, TRIP, CINAHL and ICTRP on the 18th of January 2022. Risk of bias was assessed with the Cochrane Risk of Bias tool 2.0 (ROB-2) for randomised controlled trials (RCTs) and the Newcastle-Ottowa scale for cohort studies. A total of twelve studies including two RCTs were included in this review. Results from the meta-analysis of RCTs showed the commonest side effects were constipation (RR 3.5, 95%CI 0.9-13.7) and dry mouth (RR 3.1 95%CI 0.2-53). In terms of tolerability, the effect estimate of ceasing solifenacin due to an adverse effect was 2.7 (95%CI 0.8-9.1). Within the cohort studies, out of the 779 patients 21.7% experienced side effects. The most common side effects were constipation (6.8%) and dry mouth/lips (6.0%) and 3.5% of patients ceased solifenacin due to adverse effects. Overall, the certainty of the evidence for side effects and tolerability were very low. The reported incidence of side effects is low, and less than reported with oxybutynin use. However, the very low certainty of the evidence means the findings should be interpreted with caution. There is limited reporting of a prolonged QTc interval on ECG. Studies that described this only had an increase of QTc from baseline and not a clinically significant prolonged QTc that resulted in arrhythmias. Solifenacin is an alternative anticholinergic for the treatment of OAB in children. However, given the paucity of good quality data on safety and tolerability it should be used cautiously in children with close monitoring for potential side effects.

A novel Artificial Intelligence-based tool to assess anticholinergic burden: a survey.

Backgroundmany medications possess anticholinergic activity. Their use is associated with a number of serious adverse effects including cognitive effects. The cumulative anticholinergic effect of medications as assessed by tools such as the anticholinergic burden scale (AchB) can identify people particularly at risk of anticholinergic side-effects. Currently, >20 tools are available for clinicians to use, but there is no consensus on the most appropriate tool.Methodsa newly created online tool—International Anticholinergic Cognitive Burden Tool (IACT)—based on natural language processing and chemical structure analysis, was developed and made available for clinicians to test its functions. We carried out a survey (between 8th of February and 31st of March 2021) to assess the overall need for an assessment tool as well as the usability of the IACT.Resultsa total of 110 responses were received from different countries and practitioners’ groups. The majority of the participants (86.11%) stated they would use a tool for AchB assessment if available and when they were asked to rate the IACT against other tools, amongst 34 responders, 20.59% rated it better and 8.82% rated it significantly better, 44.12% rated it neither better, nor worse, 14.71% rated it worse and 11.76% somewhat worse.Conclusionthere is a need for an anticholinergic burden calculator to assess the anticholinergicity of medications. Tools such as the IACT potentially could meet this demand due to its ability to assign scores to current and new medications appearing on the market based both on their chemical structure and reported adverse pharmacological effects.

Deprescribing Benzodiazepines in Older Adults

Benzodiazepines are well established as having the ability to produce rapid relief of anxiety and sleep disorders. However, despite their association with harm and often-short therapeutic effects, they continue to be prescribed often. Through the process of aging, the accumulation of medications needed to treat various disease states contributes to polypharmacy among the elderly. Older adults have unique factors that position them at a higher susceptibility of the anticholinergic side effects of benzodiazepines, which can result in falls, cognitive impairments and depression. Given these concerns, multiple professional organizations have identified the deprescribing of benzodiazepines as a national public health priority and have strongly recommended the pursuit of alternative shared decision-making approaches. While non- pharmacologic techniques are widely recognized to safely manage the common reasons clinicians provide when choosing to prescribe benzodiazepine’s, there is a mounting need for prescriber education regarding these practical approaches as well as evidence-based clinical practice guidelines to support successful deprescribing [1]. The purpose of this DNP project was to improve prescriber knowledge of deprescribing approaches and present alternative prescribing decisions through participation of an evidence-based education program at a geriatric specialized, primary care practice in Pennsylvania. The study participants consisted of Physicians, Nurse Practitioners and Physician Assistants who prescribe benzodiazepines. The results indicated an improvement in the participant’s knowledge of deprescribing approaches and alternative prescribing choices, as evidenced by how they rated their attitudes, knowledge and practices after participating in the evidence-based education.