The accredited CME learning activity based on this article is offered under the auspices of the CE department of the University of Toronto. Participating physicians are entitled to one (1) MAINPRO-M1 credit by completing this program, found online at www.geriatricsandaging.ca/cme

Kannayiram Alagiakrishnan, FRCP(C), Associate Professor, Division of Geriatric Medicine, Department of Medicine, University of Alberta, Edmonton, AB.
Cheryl A. Wiens, PharmD, Associate Professor, Faculty of Pharmacy & Pharmaceutical Sciences, University of Alberta, Edmonton, AB.

Numerous medications are capable of causing psychiatric side effects. Drug abuse or misuse, polypharmacy, or physiological changes due to aging may lead to these adverse effects. Drug-induced effects on mental health is a topic of considerable clinical importance and yet it is poorly recognized by health care professionals. This article is a review of psychiatric side effects of prescription and over-the-counter medications, problem recognition, and what can be done to manage and prevent these adverse events. Prevention of drug-induced psychiatric side effects can be aided by avoiding, where possible, medications that can cause these effects; evaluating renal and hepatic function on a regular basis; avoiding agents that can cross the blood-brain barrier; and conducting brief cognitive and behavioural assessments at baseline with follow up on a periodical basis.
Key words: psychiatric side effect, renal insufficiency, nonpsychiatric medications, adverse drug reactions, cognitive impairment.

Anne Grand'Maison, MD, FRCPC, Hematologist, Research Fellow, Thromboembolism Department, Sunnybrook and Women's College Health Sciences Centre; University of Toronto, Toronto, ON.
William Geerts, MD, FRCPC, Consultant in Clinical Thromboembolism, Sunnybrook and Women's College Health Sciences Centre; University of Toronto, Toronto, ON.

The elderly population is at risk of arterial and venous thromboembolic diseases. Traditional anticoagulants have demonstrated their benefits for prevention and treatment of these conditions and are accepted as standard practice. Despite this evidence, anticoagulants are still underused in older people. Practitioners often hesitate to consider anticoagulation in the elderly because of comorbidities, potential drug interactions and increased risk of bleeding. Careful assessment of bleeding risk and close monitoring of anticoagulant level are essential strategies to optimize the use of anticoagulants in the elderly. Many recently developed antithrombotics that have completed late stage of testing are presented in this review, although further studies are needed to determine their exact role, particularly in the elderly.
Key words: factor Xa inhibitor, antithrombin, renal insufficiency, drug interactions, bleeding risk index.