Prior to the QMR:

• Review the Quarterly Medication Review Deprescribing Focus – Anticholinergic Medications
• Pharmacists are asked to flag anticholinergic medications or medications with anticholinergic effects on the QMR form with a focus on medications considered to have moderate to high anticholinergic activity (see list of Drugs with Potential Anticholinergic Effect) or an anticholinergic burden score of 2 or 3 on an anticholinergic burden scale or online calculators as outlined on page 6.
  • Calculate the resident’s total anticholinergic drug burden score using the scoring tools discussed on pages 5 and 6. 
• Nurses are asked to assess and document on the QMR form if the resident is experiencing any anticholinergic side effects (see Figure 2 on page 3 for potential adverse effects of medications with anticholinergic properties).  

During the QMR:

• Review the total anticholinergic burden score and determine if the resident has a high anticholinergic burden (e.g., a total score of at least 3).
• Assess if the resident is experiencing any anticholinergic effects.
  • Consider if the resident is taking medications for the management of anticholinergic effects (e.g., laxatives for constipation, eye lubricant for dry eyes, proton pump inhibitors (PPIs) for dyspepsia, mouth moisturizers for dry mouth).
• Assess the effectiveness of the anticholinergic medication(s) or medication(s) with anticholinergic effects.
• Consider deprescribing medications with high anticholinergic burden or switching to medications with a lower anticholinergic burden. Candidates for deprescribing anticholinergic medications include:
  • Residents who have continued use of medication without improvement.
  • Residents with a high total anticholinergic burden score of 3 or higher.
  • Residents prescribed a variety of anticholinergic medications for treatment of concomitant health conditions.
  • Residents with planned or current treatment with a cholinesterase inhibitor for dementia.
  • Residents experiencing adverse effects, refer to Figure 2.
• Identify residents who may be candidates for deprescribing Medications for Overactive Bladder (OAB):
• Residents using 2 or more medications for OAB. Consider if one or more medications can be reduced or discontinued.
• Residents using medications for OAB who start showing signs of overflow incontinence due to urinary retention.47
• Residents with cardiovascular conditions; antimuscarinics and mirabegron can affect the QT interval and heart rate.
• Residents using mirabegron with blood pressure that becomes difficult to control.
• Residents using incontinence products who may no longer require OAB treatment.