Reference — Geriatrics
Beers Criteria High-Risk Medications Reference
The Beers Criteria list medications whose risks often outweigh benefits in adults 65 and older. Nurses are not prescribers — but recognizing these classes is how prescribing cascades get caught.
Data Source: AGS Beers Criteria (educational summary)
Educational use only. The Beers Criteria inform — they do not replace — prescriber judgment; never hold or change a medication without an order. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
High-Yield Classes
| Class / Drug | Why It Is Flagged | Watch For |
|---|---|---|
| Benzodiazepines (lorazepam, diazepam) | Falls, confusion, dependence; slower clearance prolongs effect | Sedation, new falls, paradoxical agitation |
| First-generation antihistamines (diphenhydramine) | Strongly anticholinergic — confusion, urinary retention, constipation | Delirium after “a sleep aid”; dry mouth; retention |
| Anticholinergics (oxybutynin, TCAs) | Cumulative anticholinergic burden impairs cognition | Confusion, blurred vision, constipation, retention |
| Long-duration sulfonylureas (glyburide) | Prolonged hypoglycemia in reduced renal function | Hypoglycemia presenting as confusion or falls |
| Sliding-scale insulin alone | Hypoglycemia risk without improved control | Glucose swings; basal coverage discussion with provider |
| NSAIDs (chronic use) | GI bleeding, renal injury, fluid retention, BP elevation | Melena, rising creatinine, edema, worsening heart failure |
| Skeletal muscle relaxants (cyclobenzaprine) | Sedation and anticholinergic effects; minimal benefit | Falls and confusion |
| Z-drugs (zolpidem) | Falls and fractures comparable to benzodiazepines | Nighttime falls, morning grogginess |
| Antipsychotics for behavior in dementia | Increased mortality and stroke risk; restraint-equivalent use | Sedation; reserve for documented severe distress per provider plan |
| Digoxin over 0.125 mg/day | Toxicity with reduced renal clearance | Nausea, bradycardia, visual changes — check level and potassium |
The Prescribing Cascade
How it happens
Drug A causes a side effect that is mistaken for a new condition, so Drug B is added — classically an antipsychotic for anticholinergic delirium, or oxybutynin for diuretic-driven urgency.
The nursing catch
Whenever a new symptom appears, screen the medication list first: what changed in the last two weeks? Bring the timeline to the provider — that is how cascades end.
NCLEX Pearls
- ✦Diphenhydramine “for sleep” causing morning confusion is the classic Beers scenario on exams.
- ✦New confusion, new falls, new retention, new constipation: four findings that should trigger a medication review.
- ✦Glyburide is the sulfonylurea to flag — long action plus aging kidneys equals prolonged hypoglycemia.
- ✦Antipsychotics are not a treatment for wandering or calling out — alternatives and cause-finding come first.
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with American Geriatrics Society (AGS) · AGS Beers Criteria. It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →