What tool would provide a recommended list of medications to avoid in a 72-year-old patient with a history of lower extremity edema, macrocytic anemia due to vitamin B12 deficiency, fungal skin infections, and osteopenia, and an elevated Hemoglobin A1C (HbA1C) level, currently residing in a long-term care facility?

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From the Guidelines

The STOPP/START Criteria would provide the most appropriate recommended list of medications to avoid for BJ, as it is specifically designed for older adults and takes into account age-related physiological changes that affect drug metabolism and clearance. This tool is particularly valuable in long-term care settings where polypharmacy is common and can help reduce adverse drug events in older adults with multiple comorbidities, such as BJ who has diabetes (A1C 8.3%), lower extremity edema, macrocytic anemia, fungal skin infections, and osteopenia 1. The STOPP (Screening Tool of Older Person's Prescriptions) component identifies potentially inappropriate medications for older adults, while the START (Screening Tool to Alert doctors to Right Treatment) component identifies potential prescribing omissions.

Given BJ's multiple conditions, the STOPP/START Criteria would help identify medications that might worsen these conditions or interact with his current treatments. For example, the criteria would consider the risk of hypoglycaemia with certain glucose-lowering drugs, the risk of hyperkalaemia with mineralocorticoid receptor antagonists, and the risk of orthostatic hypotension with diuretics and nitrates 1.

Some key points to consider when using the STOPP/START Criteria include:

  • Identifying potentially inappropriate medications, such as those that may exacerbate BJ's lower extremity edema or macrocytic anemia
  • Identifying potential prescribing omissions, such as the need for vitamin B12 supplementation in patients with macrocytic anemia
  • Monitoring for adverse effects, such as hypoglycaemia, hyperkalaemia, and orthostatic hypotension
  • Considering age-related physiological changes that affect drug metabolism and clearance, such as reduced renal function and altered volume of distribution.

Overall, the STOPP/START Criteria is a valuable tool for optimizing medication regimens in older adults like BJ, and can help improve outcomes by reducing adverse drug events and improving quality of life 1.

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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