8.3 Pharmacology of Neurocognitive Disorders

Question 1

Delirium Medications

Answer 1

• First is to correct underlying cause
• Fix fluid/electrolytes, hypoxia, diabetic issues.
• Maintain low level stimuli
• REMAIN WITH PATIENT AT ALL TIMES TO MONITOR BEHAVIOR AND PROVIDE REORIENTATION AND ASSURANCE
• Medications may exacerbate brain dysfunction
• Psychosis and agitation caused by delirium may require mechanical/chemical restraints for safety
• Benzodiazepine is common to combat substance withdrawal

Question 2

AD and Lewy Body Disease

Answer 2

• Drugs used to enhance acetylcholine

Donepezil (used for mild-moderate)
Rivastigmine
Galantamine

Side effects
- Dizziness, headache, GI issues

Memantine - Protects cells against glutamate (which contributes to NCD symptoms)

• Antipsychotics are used to control agitation, hallucinations, and disturbed thought processes for patients with NCD.

Question 3

Depression Medications

Answer 3

• Difficult to distinguish between NCD and depression
• SSRI’s (serotonin reuptake inhibitors) are the first line in elderly due to less side effects.
• Tricyclics are avoided due to cardiac and anticholinergic effects.

Question 4

Anxiety Medication

Answer 4

• NCD can cause significant anxiety
• Antianxiety medications should not be used routinely
• Benzodiazepines are the least toxic and most effective
• Drugs with shorter half lives (lorazepam) are preferred.
• Barbiturates are not appropriate due to inducing confusion and paradoxical excitement.

Question 5

Sleep Disturbance Medication

Answer 5

• Sedative/Hypnotic Medications
• Benzodiazepines