title: Psychotropics and weak opioid analgesics in plasma samples of older hip fracture patients - detection frequencies and consistency with drug records.
abstract: To determine use of psychotropic drugs and weak opioids in hip fracture patients by analysing plasma samples at admission, and compare detected drug frequencies with prescription registry data and drug records.
  
  
  
  Plasma from 250 hip fracture patients aged ≥65 years sampled at hospital admission were analysed by ultra-performance liquid chromatography-tandem mass spectrometry methods for detection of psychotropic drugs and weak opioid analgesics (alcohol also determined). Odds ratios for drugs detected in plasma of hip fracture patients vs. prescription frequencies of the same drugs in an age-, time- and region-matched reference population were calculated. Moreover, recorded and measured drugs were compared.
  
  
  
  Psychotropic drugs and/or weak opioid analgesics were detected in 158 (63%) of the patients (median age 84 years; 76% females), while alcohol was found in 19 patients (7.6%). The occurrence of diazepam (odds ratio 1.6; 95% confidence interval 1.1-2.4), nitrazepam (2.3; 1.3-4.1), selective serotonin reuptake inhibitors (1.9; 1.3-2.9) and mirtazapine (2.3; 1.2-4.3) was significantly higher in plasma samples of hip fracture patients than in prescription data from the reference population. Poor consistency between recorded and measured drugs was disclosed for z-hypnotics and benzodiazepines; e.g. diazepam was detected in 29 (11.6%), but only recorded in six (2.4%) of the patients.
  
  
  
  Plasma analysis shows that use of antidepressants and benzodiazepines in hip fracture patients is significantly more frequent than respective prescription frequencies in the general elderly population. Moreover, consistency between recorded and actual use of psychotropic fall-risk drugs is poor at hospital admission of hip fracture patients.
authors.affiliation: Center for Psychopharmacology, Diakonhjemmet Hospital, Oslo, Norway.
authors.forename: Ragnhild Birkeland
authors.initials: RB
authors.lastname: Waade
authors.affiliation: Center for Psychopharmacology, Diakonhjemmet Hospital, Oslo, Norway.|Department of Pharmaceutical Biosciences, School of Pharmacy, University of Oslo, Norway.
authors.forename: Espen
authors.initials: E
authors.lastname: Molden
authors.affiliation: Department of Surgery, Diakonhjemmet Hospital, Oslo, Norway.
authors.forename: Mette Irene
authors.initials: MI
authors.lastname: Martinsen
authors.affiliation: Department of Pharmaceutical Biosciences, School of Pharmacy, University of Oslo, Norway.
authors.forename: Monica
authors.initials: M
authors.lastname: Hermann
authors.affiliation: Department of Medicine, Diakonhjemmet Hospital, Oslo, Norway.|Department of Clinical Science, Geriatric Research Group, University of Bergen, Norway.
authors.forename: Anette Hylen
authors.initials: AH
authors.lastname: Ranhoff
mesh_terms: D000058:Accidental Falls; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000009:adverse effects / Q000097:blood*; D000928:Antidepressive Agents / Q000009:adverse effects / Q000097:blood*; D001569:Benzodiazepines / Q000009:adverse effects / Q000097:blood; D002851:Chromatography, High Pressure Liquid; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D000431:Ethanol / Q000009:adverse effects / Q000097:blood*; D005260:Female; D006620:Hip Fractures / Q000097:blood* / Q000209:etiology; D006801:Humans; D008297:Male; D009664:Norway; D016017:Odds Ratio; D012042:Registries / Q000706:statistics & numerical data; D012307:Risk Factors; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects / Q000097:blood; D053719:Tandem Mass Spectrometry
chemical_list: D000701:Analgesics, Opioid; D000928:Antidepressive Agents; D001569:Benzodiazepines; D000431:Ethanol; D017367:Selective Serotonin Reuptake Inhibitors
keywords: alcohol; fall risk; hip fracture; psychotropic drugs; weak opioid analgesics