Fall-Risk Medications

Fall-risk-increasing drugs (FRIDs) are medication classes whose pharmacological actions directly or indirectly increase the risk of falls, primarily through mechanisms of sedation, orthostatic hypotension, impaired balance, cognitive blunting, and electrolyte disturbance. The NP must understand the specific mechanisms by which each drug class increases fall risk to make informed prescribing decisions. CENTRAL NERVOUS SYSTEM DEPRESSANTS: benzodiazepines (lorazepam, diazepam, clonazepam) enhance GABAergic inhibition causing sedation, impaired psychomotor function, delayed reaction time, and anterograde amnesia; the effect is prolonged in elderly patients due to increased volume of distribution (lipophilic drugs) and decreased hepatic metabolism; Z-drugs (zolpidem, zopiclone) have similar mechanisms and similar fall risk despite marketing as 'safer' alternatives. OPIOIDS (morphine, oxycodone, hydromorphone) activate mu-opioid receptors causing CNS depression, sedation, dizziness, and orthostatic hypotension (through histamine release and vasodilation). CARDIOVASCULAR MEDICATIONS: antihypertensives cause orthostatic hypotension through different mechanisms -- alpha-1 blockers (prazosin, doxazosin) directly block peripheral vasoconstriction, centrally acting agents (clonidine) reduce sympathetic outflow, diuretics (furosemide, hydrochlorothiazide) cause volume depletion and electrolyte abnormalities (hyponatremia, hypokalemia), beta-blockers blunt the compensatory heart rate response to postural change, and ACE inhibitors/ARBs reduce angiotensin II-mediated vasoconstriction....