Appendix 2

Screening Tool to Alert doctors to Right i.e. appropriate, indicated Treatments.

The following medications should be considered for people  65 years of age with the following conditions,
where no contraindication to prescription exists.


Cardiovascular System
Warfarin in the presence of chronic atrial fibrillation. Aspirin in the presence of chronic atrial fibrillation, where warfarin is contraindicated, but not aspirin. Aspirin or clopidogrel with a documented history of atherosclerotic coronary, cerebral or peripheral vascular disease in patients with sinus rhythm. Antihypertensive therapy where systolic blood pressure consistently >160 mmHg. Statin therapy with a documented history of coronary, cerebral or peripheral vascular disease, where the patient’s functional status remains independent for activities of daily living and life expectancy is > 5 years. Angiotensin Converting Enzyme (ACE) inhibitor with chronic heart failure. ACE inhibitor following acute myocardial infarction. Beta-blocker with chronic stable angina. Respiratory System
Regular inhaled beta 2 agonist or anticholinergic agent for mild to moderate asthma or COPD. Regular inhaled corticosteroid for moderate-severe asthma or COPD, where predicted FEV1 <50%. Home continuous oxygen with documented chronic type 1 respiratory failure (pO2 < 8.0kPa, pCO2 <6.5kPa) or type 2 respiratory failure (pO2 < 8.0kPa, pCO2 > 6.5kPa). Central Nervous System
L-DOPA in idiopathic Parkinson’s disease with definite functional impairment and resultant disability. Antidepressant drug in the presence of moderate-severe depressive symptoms lasting at least three months. Gastrointestinal System
Proton Pump Inhibitor with severe gastro-oesophageal acid reflux disease or peptic stricture requiring dilatation. Fibre supplement for chronic, symptomatic diverticular disease with constipation. Musculoskeletal System
Disease-modifying anti-rheumatic drug (DMARD) with active moderate-severe rheumatoid disease lasting > 12 weeks. Bisphosphonates in patients taking maintenance oral corticosteroid therapy. Calcium and Vitamin D supplement in patients with known osteoporosis (radiological evidence or previous fragility fracture or acquired dorsal kyphosis). Endocrine System
Metformin with type 2 diabetes +/- metabolic syndrome (in the absence of renal impairment ). ACE inhibitor or Angiotensin Receptor Blocker in diabetes with nephropathy i.e. overt urinalysis proteinuria or micoralbuminuria (>30mg/24 hours) +/- serum biochemical renal impairment . Antiplatelet therapy in diabetes mellitus if one or more co-existing major cardiovascular risk factor present (hypertension, hypercholesterolaemia, smoking history). Statin therapy in diabetes mellitus if one or more co-existing major cardiovascular risk factor present.  estimated GFR <50ml/min.

Source: http://polypharmacy.ca/wp-content/uploads/2013/10/START-criteria-for-elderly-prescribing1.pdf

Fopg 2653.4 web version

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