4CPS-180 Applying different scales for calculating the anticholinergic burden in older patients

Abstract

BackgroundAnticholinergic scales (AS) are defined as medication lists that classify drugs according to their anticholinergic potential. They use different criteria for defining the anticholinergic properties of drugs. The sum of the score of each drug included in the scale is the anticholinergic burden (AB). AB can detect patients with a high risk of cognitive and functional adverse events.PurposeTo estimate the anticholinergic risk (AR) in elderly patients based on different AS.Material and methodsA cross-sectional study that included all elderly patients residing in a nursing home in September 2017. Age, sex and pharmacotherapy were collected for each patient. AB was calculated using 10 different AS described in a systematic review.1. They are as follows: Anticholinergic Cognitive Burden Scale (ACB), Anticholinergic Risk Scale (ARS), Chew’s scale (CS), Anticholinergic Drug Scale (ADS), Anticholinergic Activity Scale (AAS), Anticholinergic Load Scale (ALS), Clinician-Rated Anticholinergic Scale (CRAs), Duran’s scale (DS), Anticholinergic Burden Classification (ABC) and Drug Burden Index (DBI). The scales offer final AR scores classified in three groups: low, medium and high, according to the risk categorisation made by the authors of each scale. Higher scores are associated with increased AR.ResultsWe analysed 248 patients; mean age: 82.5±10 years, 72.6% females. Mean prescribed drugs: 8.2±3.4. All AS identified patients with AR (Table). We identified 68 drugs, with anticholinergic potency being the most common: furosemide (27%), lorazepam (20.6%), metformin (14.7%), quetiapine (12.5%).Abstract 4CPS-180 Table 1 Low n (%) Medium n (%) High n (%) ACB 79 (27.8) 38 (15.3) 46 (18.5) ARS 73 (29.4) 24 (9.7) 7 (2.5) CS 36 (14.5) 24 (9.7) 18 (7.3) ADS 55 (22.2) 32 (12.9) 44 (17.7) AAS 37 (14.9) 13 (5.2) 13 (5.2) ALS 65 (26.2) 37 (14.9) 16 (6.5) CRAs 50 (20.2) 40 (16.1) 28 (11.3) DS 80 (32.3) 28 (11.3) 9 (3.6) ABC 0 0 95 (38.3) DBI 0 90 (36.3) 81 (32.7) ConclusionA high proportion of elderly patients are at risk of anticholinergic adverse events because of treatment. Due to varying identification and scoring criteria for anticholinergic drugs, the AS used revealed extensive differences in calculating AB. However, detection of AR can be an important strategy for optimising treatment in those patients.Reference and/or Acknowledgements1. Villalba-Moreno AM, Alfaro-Lara ER, Pérez-Guerrero MC, et al. Systematic review on the use of anticholinergic scales in polypathological patients. Arch Gerontol Geriatr2016;62:1–8.No conflict of interest

Pharmacovigilance

“…Peripheral side effects of anticholinergic drugs are dry mouth, nausea, vomiting, constipation, bloated feeling, abdominal pain, loss of taste, and anorexia, and also ophthalmic side effects occur (blurred vison, diplopia, mydriasis, increased ocular tension); central side effects are dizziness, lightheadedness, tingling, headache, drowsiness, weakness, nervousness, numbness, mental confusion, excitement, dyskinesia, lethargy, syncope, speech disturbance, and insomnia (Collamati et al 2016). To predict the risk of known ADEs in the treatment with anticholinergic drugs, in vitro methods and anticholinergic scales have been developed (Cantudo Cuenca et al;Villalba-Moreno et al 2016), but none of these methods have been standardized, and there is no consensus on how to define drug exposure (Collamati et al 2016). Psychoactive drugs in general affect the cardiovascular system (Brouillette and Nattel 2017).…”