221017 PA Acute agitation

Question 1

Acute agitation
Risk factors?

Answer 1

Bệnh tâm thần có sẵn
Lạm dụng chất kích thích
“Bỏ thuốc” trầm cảm
Căng thẳng
Grief: mất mát ng thân

Question 2

Acute agitation
Các thuốc gây kích động?

Answer 2

Anticholinergics vì gây rối loạn, confused
Bỏ thuốc opioid/BZD
Corticosteroid vì tăng testosterone, nên hung hăng
Dopamin và đồng vận dopamin => các bệnh tâm thần

Question 3

Acute agitation
Thuốc điều trị?

Answer 3

1. BZD (lorazepam, midazolam)
2. 1st antipsychotics (haloperidol, loxapine)
3. 2nd antipsychotics (olanzapine, risperidone, ziprasidone)

Question 4

Acute agitation
Benzodiazepines IM chỉ định

Answer 4

Agitation: CNS stimulant intoxication, alcohol withdrawal, undifferentiated agitation
Delirium (mê sảng): BZD/alcohol withdrawal, sleep deprivation

Question 5

Acute agitation
1st and 2nd antipsychotics chỉ định

Answer 5

Agitation: CNS depressant intoxication, known psychiatric disorder
Delirium: not cases of BZD indication

Question 6

Acute agitation
Combination may cause death

Answer 6

parenteral BZD + olanzapine => cardiac and respiratory complications

Question 7

Acute agitation
Less expensive drugs

Answer 7

2nd gen

Question 8

Acute agitation
Combination therapy brings more effective

Answer 8

BZD + 1st gen

Question 9

Acute agitation
“5 and 2” meaning

Answer 9

5mg haloperidol + 2 mg lorazapam (both: IM or IV)

Question 10

Acute agitation
SE of haloperidol (2)

Answer 10

EPS + QTc prolongation

Question 11

Acute agitation
Combination as effective as “5 and 2”

Answer 11

PO risperidone + lorazepam

Question 12

Acute agitation
Best studied in agitation 2nd gen

Answer 12

risperidone

Question 13

Acute agitation
Less effective 2nd gen / agitation

Answer 13

aripiprazole

Question 14

Acute agitation
2nd gen has SE: significant orthostatic hypotension

Answer 14

quetiapine => not preferred in emergency room

Question 15

Acute agitation
2nd gen has SE: significant QTc prolongation

Answer 15

ziprasidone

Question 16

Acute agitation
Compare: olanzapine with haloperidol

Answer 16

Less EPS
More expensive
More sedating

Question 17

Acute agitation
Dementia pt.
long-term antipsychotic use related to

Answer 17

higher risk of stroke and death => shortest duration possible
Consider: benefits outweigh the risks

Question 18

Acute agitation
Elderly

Answer 18

lower dose of antipsychotics
shortest duration
monitor closely

Question 19

Acute agitation
Common causes

Answer 19

Toxicologic: rượu, chât kích thích
Neurologic: stroke, CNS infection, seizure, dementia, intracranial lesion
Medical: hyperthyroidism, hyperthermia, hypothermia, hypoglycemia, shock, AIDS, hypoxia
Psychiatric:
Psychosis, schizophrenia, paranoid delusions, personality disorder

Question 20

Acute agitation

2nd gen treats agitation and other behavioural symptoms linked to Alzheimers

Answer 20

Risperidone

Question 21

Acute agitation

2nd gen treats agitation and other behavioural symptoms linked to Alzheimers

Answer 21

Risperidone