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PEBC > 1 - Acute Agitation > Flashcards

1 - Acute Agitation Flashcards

1
Q

non-pharms for acute agitation?

A

calm voice, reassure them, re-orient with clocks and dates and places, ensure enough sleep, etc.

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2
Q

Are antipsychotics safe in those with dementia?

A

antipsychotics used for several weeks to months can increase risk of stroke and death in elderly patients with dementia

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3
Q

What are causes of delirium?

A

infection, substance intoxication or withdrawal, metabolic abnormalities, trauma, hypoxia, deficiencies, arrhythmia, stroke, dehydration

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4
Q

What drug class is 1st line for acute agitation caused by delerium?

A

1st line = antipsychotics

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5
Q

Agitation from Delerium:

______ is most studied by HC but not officially approved for this

A

haloperidol (IM or IV)

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6
Q

Agitation from Delerium:

What other antipsychotics can you use?

A
  • loxapine (1st gen)

- olanzapine, risperidone or quetiapine (2nd gen)

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7
Q

1st gen antipsychotics have more risk of ____ side effects

A

EPS

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8
Q

What are EPS side effects?

A

NMS, akathisia, tardive dyskinesia

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9
Q

What 2nd gen antipsychotic has higher risk of EPS than all others, especially at higher doses?

A

risperidone

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10
Q

Agitation from Delerium:

What situations should BZD be reserved for?

A

those cases of delirium related to alcohol or BZD withdrawal

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11
Q

2nd gen antipsychotics have more risk of ____ side effects

A

metabolic (weight gain, dyslipidemia, etc.)

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12
Q

Agitation from Delirium:

If using BZD, what characteristics would be preferable?

A

long half life (ex. diazepam or chlordiazepoxide)

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13
Q

Agitation from Dementia:

1st line = ?

A

non-pharms

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14
Q

Agitation from Dementia:

If response is not adequate in __ weeks, or s/e occur, stop/taper the drug

A

4

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15
Q

Agitation from Dementia:

If med is effective, when should you try to stop or taper ?

A

within 4 months

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16
Q 
Agitation from Dementia:
Which class is preferred?
A

2nd gen

17
Q

Agitation from Dementia:

Which antipsychotics are favourable for agitation from Alzheimer’s?

A
  • risperidone is good, has effects on total behaviour, aggression, and psychosis
  • olanzapine may reduce aggressiveness, anxiety and euphoria
  • little evidence for quetiapine
18
Q

Agitation from Dementia:

Patients with what type of dementia may have enhanced sensitivity to first and second gen antipsychotics?

A

lewy body dementia

19
Q

Agitation from Dementia:

For Lewy Body Dementia, what drugs should you consider?

A

Cholinesterase inhibitors (donepezil, rivastigmine, galantamine) or memantine

*see dementia for more on these drugs!

20
Q

Agitation from Dementia:

Which SSRIs only proved modest reduction?

A

citalopram or sertraline

21
Q

Agitation from Dementia:

Is trazodone good?

A

evidence unclear and can cause postural hypotension so risk of falls

22
Q

Agitation from Dementia:

What are the oral BZD of choice if necessary? (remember these are last line)

A

lorazepam (only one that’s injectable), oxazepam, temazepam

23
Q

Agitation from Dementia:

Why is lorazepam, oxazepam and temazepam the agents of choice if BZD need to be used?

A
  • no active metabolites

- metabolism is minimally affected by aging

24
Q

Agitation from Brain Injury:

High doses of ______ were effective in reducing incidence of aggression

A

propranolol

25
Q

Agitation from Brain Injury:

What other types of medications can be used?

A

Antidepressants
Antiepileptcis
Antipsychotics

*concern about BZD and paradoxical disinhibition in those with brain injury

26
Q

Agitation from Psychosis:

What drugs are first line?

A

short acting IV forms of antipsychotics (ex. haloperidol) used alone or in combo with IV lorazepam

27
Q

Why can you not combine IM olanzapine with IM BZD ???

A

can result in cardiac and respiratory complications

28
Q

Agitation from Psychosis:
If patient does not want injectable, can also use orally dissolving antipsychotics. Which ones are available as orally dissolving tablets?

A

Risperidone and olanzapine (2nd gen)

29
Q

Agitation from Mania:

What are the two parts of treatment?

A
  • short term treatment of mania

- long term mood stabilizers

30
Q

Agitation from Mania:

What are good initial drugs to treat short term mania?

A

2nd gen antipsychotics (olanzapine, quetiapine, aripiprazole, ziprasidone)

31
Q

Agitation from Situational:

What is essential ?

A

non-pharms (counselling, calm voice, reassurance, etc.)

32
Q

Agitation from Situational:

What are the most common meds used?

A

1st gen antipsychotics + BZD (oral or IM)

*sometimes 2nd gen antipsychotics are used

PEBC (130 decks)

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