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systematic reviews, published in the last 10 years, in English or

Portuguese. It was also carried out research in textbooks and



Atypical antipsychotics are a good therapeutic option to

control behavioral and psychological symptoms in dementia.

However, they should be used with caution, optimizing the dose and

duration treatment. Common target dose ranges in dementia are


1 mg of risperidone, 2.5

7.5 mg of olanzapine, 12.5

150 mg of

quetiapine, 5

10 mg of aripiprazole. Treatment should be short-term


12 months) and discontinued with a 3

6 months

history of

behavioral stability. Beers Criteria recognize the increased risk of

stroke and mortality associated to antipsychotics treatment in people

with dementia, and that they should be avoided unless patient is threat

to self or others.

Key conclusions:

Behavioral disorders and psychopathological symp-

toms associated with dementia decrease patient

s quality of life

and cause physical and psychological stress of caregiver. Antipsychotic

agents have an important role in controlling these symptoms.

Therefore, medical community must have an adequate knowledge of

efficacy, risks and correct use of these drugs.


Polypharmacy in elderly patients admitted to Acute Medical

Wards, Hospital Sungai Buloh, Malaysia

S.M. Mohd Shariff


, B.S. Teoh, T. Marimutu


, J. Supayah


, W.M. Wan



, M.L. Saimon


, M. Francise


, N. Nordin




Department of

Pharmacy, Hospital Sungai Buloh,


Geriatric Unit, Medical Department,

Hospital Sungai Buloh,


Department of Rehabilitation, Hospital Sungai



Several studies show that over-prescribing in elderly is

frequently associated with unwanted side effects and medicine

interactions. This study aims to observe the demographics of elderly

patients admitted to our acute medical wards and the prevalence of

polypharmacy among the elderly.


Elderly patients admitted were interviewed for medication

histories. Data on demographics, patient

s medication lists and

discharge outcome were gathered. STOPP Criteria along with Beers

were used to decide for potential medicine that could be stopped. Data

were prospectively collected over a 12-week period, and analysed via

SPSS version 20.0.


Out of the 209 paients, only 61.7% (129) patient data

were analyzed after exclusions. 14% of the population were above

80 years old and 46.6% were male, (64). 31/64 of the males were in

the age group of 71

80 years (p

0.26). Malays dominated, 57.4%

(74) and 79.8% had multiple admission. 50/129 (38.8%) presented

with polypharmacy on admission and significantly associated

with PIP according to STOPP and Beers (p

0.000). Polypharmacy

was also associated with ADR, for which 4/6 patients with ADR

experienced polypharmacy (p

0.15). Polypharmacy on admis-

sion was not associated to age group, ethnicity and education

level. On discharge, 43.4% (56) were on polypharmacy. 33/50

patients on polypharmacy during admission remained to be on

polypharmacy on discharge (p

0.000). Among those with poly-

pharmacy on discharge, 55.3% (31) has potential. On discharge,

nearly half (55.3% (31)) still had at least one potential medicine that

can be stopped.


There was high prevalence of polypharmacy and PIP use

in older adults both pre admission and on discharge. Interventions

should be done to minimize this occurrence via the STOPP and Beers

criteria. Abbreviation: ADR: Adverse Drug Reactions PIP: Potentially

Inappropriate Prescription


Acute kidney failure due to anti-inflammatory drugs and

antihypertensive drugs in elderly inpatients

D. Oliveira


, S. Silva


, P. Dias


, J. Feio




Centro Hospitalar e Universitário

de Coimbra, Coimbra, Portugal



triple whammy

refers to the combination of

diuretics, non-steroidal anti-inflammatory drugs (NSAIDs), ACE

inhibitors (ACEI) and/or angiotensin receptor antagonists (ARA) that

may impair the kidney function (KF).


To identify the risk of the triple whammy in hospitalized

elderly patients prescribed with NSAIDs and antihypertensive drugs

(AHTd) simultaneously.


We selected elderly inpatients (

65 years old) from all

inpatients prescribed with NSAIDs and AHTd simultaneously, during

the first half year/2015. For patients medicated with NSAIDs plus ACEI/

ARA plus diuretics, we evaluated change in serum creatinine and

estimated glomerular filtration rate (eGFR)

MDRD calculator. Data

was analysed using Excel2007




396 of 662 inpatients medicated with NSAIDs and AHTd

simultaneously were elderly. 156 elderly inpatients (39%) were

prescribed with NSAIDs plus ACEI/ARA plus diuretic (mean age: 76

years old); most (28%) were prescribed in the orthopedic ward. 40%

were using 1 NSAID plus 1 ACEI plus 1 diuretic. The most common

NSAID was cetorolac (31%) while losartan (39%), enalapril (39%) and

furosemide (67%) were the most used ARA, ACEI and diuretic,

respectively. 32% of them saw a decline of their KF, 30% were not

monitored and 38% remained stable. Among patients with worsened

KF the average increase of serum creatinine was of 0.72+/

0.69 mg/dL

and eGFR decrease was of 27.5+/

20.22 mL/min.


The prevalence of elderly inpatients medicated with

NSAIDs plus ACEI/ARA plus diuretics is considerably high given that


re a susceptible population to suffer from

triple whammy

, a

potentially serious preventable adverse effect.


Serotonin syndrome and polypharmacy

R. Ortés-Gómez, G. Lozano-Pino, E. Villalba-Lancho.

Geriatrics Unit,

Virgen del Puerto Hospital, Plasencia (Cáceres), Spain


The serotonin syndrome is a potentially life-threatening

adverse drug reaction that can be caused by the use of drugs that

increase the availability of serotonin. Elderly people are at risk of

serotonin syndrome because of comorbidity and polypharmacy. We

describe a case of serotonin syndrome in an 84-year-old woman.


Mrs. M., an 84-year-old woman with a history of

depression and osteoarthritis, was admitted to hospital with a

3-days history of hypervigilance, insomnia, tremor and difficulty

with speech articulation. She was polymedicated and she had been

taken paroxetine 30 mg daily, quetiapine 25 mg daily and fentanyl

25 mcg every three days. On exam, Mrs. M. was dehydrated and

afebrile and she had agitation, tachycardia, shivering, stiffness,

diaphoresis, mydriasis, horizontal ocular clonus and inducible clonus

in the lower extremities.


We though about the possibility of serotonin syndrome

and we started treatment with parenteral fluids and benzodiazepines

after stopping oral treatment and fentanyl. Instead treatment,

Mrs. M. started with hyperthermia, autonomic instability, rhabdo-

myolysis and renal failure and we added parenteral chlorpromazine.

After this we could control agitation, diaphoresis, shivering and

stiffness with persistence of hyperthermia and tachycardia. Lastly,

Mrs. M. died after sudden cardiorespiratory arrest.

Key conclusions:

Serotonin syndrome is a predictable consequence

of excess serotoninergic agonism on serotoninergic receptors and it

is a potentially life-threatening adverse drug reaction. Elderly people

are at risk of serotonin syndrome because of comorbidity and



Orthogeriatrics unit: an opportunity to medication reconciliation

in the elderly with hip fracture

R. Pérez López, M.M. Luis, C. Pablos Hernández, A. González Ramírez,

J.M. Julián Enríquez, J.F. Blanco Blanco.

Universitary Hospital of


Poster presentations / European Geriatric Medicine 7S1 (2016) S29