Geriatric emergency medication safety recommendations

Therapeutic Class	Alternatives	Exclusions
Barbiturates	Epilepsy: use other anticonvulsants (e.g., lamotrigine, levetiracetam). Agitation: treat pain first with acetaminophen then low-dose opioid. Severe agitation: use low-dose second-generation antipsychotic (eg, olanzapine, risperidone, quetiapine [Lewy body dementia]).	Seizures disorders, benzodiazepine or ethanol withdrawal, barbiturates are acceptable to use.
Benzodiazepines	Epilepsy: use other anticonvulsants (eg, lamotrigine, levetiracetam). Agitation: treat pain first with acetaminophen then low-dose opioid. Severe agitation: use nonpharmacologic approach then low-dose second-generation antipsychotic (eg, olanzapine, risperidone, quetiapine [Lewy body dementia]).	Seizure disorders: benzodiazepine or ethanol withdrawal, severe generalized anxiety disorder, and end of life, benzodiazepines are acceptable to use.
First-Generation Antihistamines	Allergies: use intranasal saline or steroid (eg, fluticasone, beclomethasone), topical antihistamines (eg, azelastine), or second-generation antihistamines (eg, fexofenadine, loratadine). Vertigo: use short-term steroids and canalith repositioning maneuvers.	For allergic reactions, first-generation antihistamines are acceptable to use.
Metoclopramide	For nausea, use ondansetron.	For gastroparesis, metoclopramide is acceptable to use.

See Also

• Geriatrics (main)