Agitation Aggression Delirium and elderly

Question 0

Pharm mgmt of agitation aggression

Answer 0

FGA like haldol
BZD
SGA

• all antipsychotics equally effective

Question 1

Goal of tx of aggression agitation

Answer 1

Keep pt safe and calm

Question 2

If delirium considered as cause of agitation/aggression, what do you not want to consider as treatment?

Answer 2

BZD

Question 3

Chloropromazine side effect

Answer 3

Orthostatis

So dose is 25 mg IM

Question 4

CAM

Answer 4

Confusion assessment method
- adaptable to setting eg cam-icu

Screening: yes or no to the presence of delirium

Identified presence but not severity of delirium , and not good for monitoring progress

Part one screens for overall cognitive impairment. Part 2 to distinguish delirium from other types of cognitive impairment.

Question 5

DRS

Answer 5

Delirium Rating Scale
Monitor sx over time 
Max score is 32
Cutoff for delirium = 12
10 item clinician administered scale
Each item 0 ton2,3,4 depending on item

Question 6

MDAS

Answer 6

Memorial delirium assessment scale
10 item 4 pt scale with max score 30
Cut off score 10-13 for delirium

Question 7

DI

Answer 7

Delirium index
Severity index
Below 5 means pt not delirious
Items 0-3 with max of 21

Question 8

Ap for Lewy body dementia related psychosis sx

Answer 8

Clozapine
Quetiapine
Bc of low dopamine blockade r/t other antipsychotics

Question 9

Donepezil moa

Answer 9

Inhibits AChE

Question 10

Galantamine moa

Answer 10

Inhibits ache and modulates activity at nicotinic receptors

Dose in 4mg bid increments q 4 weeks up to 12mg BID (24mg/day)

Question 11

Rivastigmine mía

Answer 11

AchE and butylcholinesterase inhibitor

1.5 mg bid up every 2 weeks
Most GI sx

Renal eliminated

Question 12

Tacrine moa

Answer 12

Ache, butyrlacholinestrrase and musc and nicotinic

Question 13

Catie AD trial showed which antipsychotics had best benefit for dementia related neuropsychiatric sx (NPS)

Answer 13

Risperidone
Aripiprazole
Olanzapine in last case carried forward

Question 14

Mortality associated with SGA in elderly

Answer 14

Cardiac related conditions eg MI , CHF