1 - Acute Agitation Flashcards
non-pharms for acute agitation?
calm voice, reassure them, re-orient with clocks and dates and places, ensure enough sleep, etc.
Are antipsychotics safe in those with dementia?
antipsychotics used for several weeks to months can increase risk of stroke and death in elderly patients with dementia
What are causes of delirium?
infection, substance intoxication or withdrawal, metabolic abnormalities, trauma, hypoxia, deficiencies, arrhythmia, stroke, dehydration
What drug class is 1st line for acute agitation caused by delerium?
1st line = antipsychotics
Agitation from Delerium:
______ is most studied by HC but not officially approved for this
haloperidol (IM or IV)
Agitation from Delerium:
What other antipsychotics can you use?
- loxapine (1st gen)
- olanzapine, risperidone or quetiapine (2nd gen)
1st gen antipsychotics have more risk of ____ side effects
EPS
What are EPS side effects?
NMS, akathisia, tardive dyskinesia
What 2nd gen antipsychotic has higher risk of EPS than all others, especially at higher doses?
risperidone
Agitation from Delerium:
What situations should BZD be reserved for?
those cases of delirium related to alcohol or BZD withdrawal
2nd gen antipsychotics have more risk of ____ side effects
metabolic (weight gain, dyslipidemia, etc.)
Agitation from Delirium:
If using BZD, what characteristics would be preferable?
long half life (ex. diazepam or chlordiazepoxide)
Agitation from Dementia:
1st line = ?
non-pharms
Agitation from Dementia:
If response is not adequate in __ weeks, or s/e occur, stop/taper the drug
4
Agitation from Dementia:
If med is effective, when should you try to stop or taper ?
within 4 months
Agitation from Dementia: Which class is preferred?
2nd gen
Agitation from Dementia:
Which antipsychotics are favourable for agitation from Alzheimer’s?
- risperidone is good, has effects on total behaviour, aggression, and psychosis
- olanzapine may reduce aggressiveness, anxiety and euphoria
- little evidence for quetiapine
Agitation from Dementia:
Patients with what type of dementia may have enhanced sensitivity to first and second gen antipsychotics?
lewy body dementia
Agitation from Dementia:
For Lewy Body Dementia, what drugs should you consider?
Cholinesterase inhibitors (donepezil, rivastigmine, galantamine) or memantine
*see dementia for more on these drugs!
Agitation from Dementia:
Which SSRIs only proved modest reduction?
citalopram or sertraline
Agitation from Dementia:
Is trazodone good?
evidence unclear and can cause postural hypotension so risk of falls
Agitation from Dementia:
What are the oral BZD of choice if necessary? (remember these are last line)
lorazepam (only one that’s injectable), oxazepam, temazepam
Agitation from Dementia:
Why is lorazepam, oxazepam and temazepam the agents of choice if BZD need to be used?
- no active metabolites
- metabolism is minimally affected by aging
Agitation from Brain Injury:
High doses of ______ were effective in reducing incidence of aggression
propranolol
Agitation from Brain Injury:
What other types of medications can be used?
Antidepressants
Antiepileptcis
Antipsychotics
*concern about BZD and paradoxical disinhibition in those with brain injury
Agitation from Psychosis:
What drugs are first line?
short acting IV forms of antipsychotics (ex. haloperidol) used alone or in combo with IV lorazepam
Why can you not combine IM olanzapine with IM BZD ???
can result in cardiac and respiratory complications
Agitation from Psychosis:
If patient does not want injectable, can also use orally dissolving antipsychotics. Which ones are available as orally dissolving tablets?
Risperidone and olanzapine (2nd gen)
Agitation from Mania:
What are the two parts of treatment?
- short term treatment of mania
- long term mood stabilizers
Agitation from Mania:
What are good initial drugs to treat short term mania?
2nd gen antipsychotics (olanzapine, quetiapine, aripiprazole, ziprasidone)
Agitation from Situational:
What is essential ?
non-pharms (counselling, calm voice, reassurance, etc.)
Agitation from Situational:
What are the most common meds used?
1st gen antipsychotics + BZD (oral or IM)
*sometimes 2nd gen antipsychotics are used
