042115 delirium

Question 1

causes of delirium

Answer 1

• metabolic/endocrine (hypona, hyperna, hypo/hyperthyroidism)
• infectious dis
• cerebrovascular event (both hemispheres or bainstem)
• cardiovascular (MI)
• drugs or toxicity
• hypoperfusion
• others (pneumonia)

Question 2

what drugs can cause delirium

Answer 2

alcohol withdrawal
diuretics
anticholinergics
corticosteroids
digoxin
opioids
antidepressants
anxiolytics
hallucinogens
benzodiazepines
sympathomimetics

Question 3

common age related causes of altered mental status/coma

Answer 3

infant: infec, trauma, metabolic
child: toxic ingestion
adolescent, young adult: toxic ingestion, recretaional drug use, trauma

elderly: medication changes, OTC meds, infection, alterations in living environment, stroke, trauma

Question 4

most important clue to delirium

Answer 4

acuity of onset, fluctuation in course

Question 5

what should you do for delirium pt?

Answer 5

FIRST: ABCs
talk to EMS, family
basic neuro exam (focal deficits?)
differential 
work-up (DON'T coma cocktail, labs, imaging, other tests)
tx

Question 6

coma cocktail

Answer 6

dextrose, oxygen, naloxone, thiamine

Question 7

which drugs can increase insulin secretion?

Answer 7

sulfonylureas

meglitinides

Question 8

teenager-at party, found with bounding peripheral pulses and tachycardia-differential?

Answer 8

stimulant-amphetamine, cocaine, methamphetamine, PCP, robutussin, salvia, MDMA, bath salts, psychiatric, hypoglycemic, head trauma, infectious, drug withdrawal

Question 9

all of the following sympathomimetic drugs inhibit uptake of NE except: cocaine, ampheatmine, venlafaxine, bupropion, dobuatmine

Answer 9

dobutamine (direct beta adrenergic receptor agonist)

Question 10

monoamines

Answer 10

dopamine
NE
epinephrine
serotonin

Question 11

selegiline

Answer 11

MAO inhibitor (indirect acting sympathomimetic)

Question 12

ex of indirect acting sympatohomimetics

Answer 12

cocaine
amphetamines (false substrate for DAT, NET, VMAT)
MDMA
bath salts

Question 13

ex of sympathomimetics

Answer 13

bath salts
phenylephrine
dopamine
methylphenidate
bupropion
tramadol
isoproterenol
albuterol
terbutaline
ergot alkaloids

Question 14

sympathomimetic toxidrome

Answer 14

HTN, hyperthermia, tachycardia, mydriasis, diaphoresis

Question 15

opioid toxidrome

Answer 15

altered mental status (stupor, coma)
miosis
respiratory depression

Question 16

Wernicke’s encephalopathy includes

Answer 16

confusion, ophthalmoplegia, ataxia

Question 17

ethanol’s targets

Answer 17

GABA receptors (Cl flux)
NMDA receptors (an antagonist)

Question 18

other things that bind GABA receptor (other than alcohol)

Answer 18

benzodiazepines
propofol
barbiturates

Question 19

other things that bind to NMDA receptors (other than alcohol)

Answer 19

ketamine, PCP

Question 20

delirium tremens

Answer 20

hallucinations (visual, tactile)
disorientation
HTN
tachycardia
fever
high risk for seizures, arrhythmias

from alcohol withdrwal, 2-4 days after last drink