AMS 2- SG Flashcards
Sxs of what?
- Autonomic hyperactivity (diaphoresis, tachycardia, systolic HTN)
- Tremors
- Insomnia
- Transient hallucinations
- Nausea or vomiting
- Psychomotor agitation, restlessness
- Anxiety
- Seizures
- Loss of appetite / rejection of all food
- Confusion
Acute Alcohol Withdrawal
Tx what w/ Benzos??
AMS is never tx w/ Benzos, but this is the 1 exception.
Acute Alcohol Withdrawal
Result of what?
- Medical emergency manifest by extreme autonomic hyperactivity w/ delirium
- Can have psychosis, agitation, withdrawal seizures
- Hyperadrenergic activity –> cause of mortality (if not tx appropriately)
Delirium Tremens (DTs)
(Severe Alcohol Withdrawal)
W/ Delirium Tremens from Severe Alcohol Withdrawal, what is the usual cause of mortality if pt is not treated appropriately?
Hyperadrenergic activity
Wernicke’s Encephalopathy
- Medical emergency caused by ____.
- Characterized by what 3 things?
- Most cases associated w/ which 2 things?
- Thiamine deficiency
- Ophthalmoplegia / Ataxia / Confusion
- Alcoholism / Malnutrition (or both)
Failure to tx/recognize Wernicke’s Encephalopathy may result in which 2 things?
- Death
- Permanent neurologic impairment
Wernicke’s Encephalopathy
- What are the 2 main treatments?
- Tx if associated w/ ETOH?
- Thiamine & Multivitamin
- Benzos if ETOH
A toxin of AMS called Anti-Freeze
Ethylene glycol
2 types of tests for AMS to test for Toxins
- Urine Drug Screen
- Serum Screening
Which test?
- Opioids
- Benzos
- Cocaine
- THC
- Barbiturates
- Amphetamines/Methamphetamines
- TCAs
- Buprenorphine
Urine drug screen
Which test?
- Acetaminophen
- Salicylate
- Carboxyhemoglobin
- Digoxin
- Lithium
- Valproic acid
- Iron
- Ethylene glycol
- Lead / mercury
Serum screening
Management of AMS
Address the ABCs:
- Airway
- Breathing
- Circulation
What 7 things need to be addressed before initiating interventions for AMS?
- VS
- mental status
- Pupil size
- skin temp
- pulse ox
- cardiac monitoring
Why do you give Thiamine in the SNOT cocktail before giving glucose?
To avoid inducing Wernicke-Korsakoff Syndrome
Tx of AMS is: Identify underlying cause and tx this underlying cause
- what is the “SNOT” cocktain for pts w/ AMS?
- Sugar (glucose)
- Naloxone (Narcan)
- Oxygen
- Thiamine
Which condition?
- A progressive intellectual decline
- NOT due to delirium or psychiatric disease
- 4 types
Dementia
- 5 risk factors of Dementia
- What are the 4 types?
- Age >65
- Family hx
- Vascular Disease
- DM
- Hx of significant head injury
Four Types:
- Alzheimers (MC)
- Vascular dementia
- Dementia w/ Lewy Bodies
- Frontotemporal dementia (Luis)
Dementia
- Typically begins after age ___.
- Prevalence doubles every __ yrs after age ___.
- By ___ y/o approximately 50% have some form of dementia
- Cause is mostly acquired or genetic?
- More prevalent among men or women?
- 65
- 5 years after age 65
- 85 y/o
- Acquired, (some genetic for early onset)
- Women
_____ is the most common form of dementia.
- Major public health issue
- How is definitive dx made?
- What is the only therapy available?
Alzheimer Disease
- Autopsy or brain biopsy
- Symptomatic therapies
Which condition?
- Type of progressive dementia caused by microscopic deposits that damage brain cells over time
Dementia w/ Lewy Bodies
Lewy Bodies are found in Dementia w/ Lewy Bodies and what other 2??
- Alzheimer Disease
- Parkinson Disease (more common in this one)
Dementia w/ Lewy Bodies
- Deposits of beta-amyloid?
- Twisted fiber of tau protein?
- Plaques
- Tangles
Which condition?
- Caused by impaired blood flow to the brain
- Often occurs after stroke
- Multifocal ischemic change
- “dramatic onset” - Impairment is often more sudden than Alzheimer Dz
Vascular Dementia
3 risk factors of Vascular Dementia
- HTN
- HLD
- Smoking
Dementia have short or long term memory loss?
Short
- Pts w/ ____ are susceptible to episodes delirium.
- Recognition of ____ is not possible until _____.
- ___ is typically dx in what setting?
- Pt should be stable when diagnosed, not acutely ill.
- Dementia
- Dementia / the delirium lifts
- Dementia / Outpatient setting
- ____ can lead to impaired cognition in patients w/ depression or anxiety
- (–> poor ___ and ____)
- ___ sxs should improve w/ tx
- Can be early symptom of ______.
- If untreated, what disorder may predispose an individual to age related dementia?
-
Psychiatric disease
- poor focus & concentration
- psychiatric sxs
- dementia
- Persistent modd disorder
Although ____ and/or ___ are signs of both Delirium and Dementia, these are different conditions.
- Confusion &/or Disorientation
- Acute confusional state
- Is potentially reversible
- Usually occurs over a period of days to months
Delirium
- Slow & insidious
- Progresses slowly over months to years
- NOT reversible
- (can slow sxs w/ meds, but cannot be cured)
Dementia
- What needs to be established when pt presents w/ Dementia?
- Document pt’s current ability to complete ____.
- Time of symptom onset
- Activities of daily life (ADL)
Dementia psych workup:
- ____
- Periodic screening for pts ___ y/o or over
- Evaluation by ______.
- MMSE
70 - trained neuropsychologist
What test for Dementia is indicated if:
- Pts w/ new / progressive complaint
- ___ is preferred test
- ____ is used to r/o amyloid pathology
Brain imaging
- MRI preferred
- Positive-emission tomography (PET)
7 labs to obtain for Dementia workup
- Serum B12
- TSH
- RPR
- CBC
- CMP
Lipids - ApoE gene testing
What lab should you order if Alzheimer disease is in differential? Why?
ApoE gene testing (esp young patients bc/ good to catch early to tx)
2 treatments for Dementia
- Aerobic exercise (45 mins)
- Frequent mental stimulation
Tx for Dementia w/ Lewy Bodies
(Small effect on cognition, mood, behavior)
Memantine
3 treatments for Alzheimer Disease and what type of drug they are.
Cholinesterase Inhibitors
- Donepezil (mild to moderate dz)
- Rivastigmine
- Memantine (moderate to severe dz)
Mood/Behavioral tx for Dementia
- _____ are generally safe
- Avoid ____ due to anticholinergic effect
- _____ for insomnia
- SSRI
- Paroxetine
- Trazadone
What is the name of a Psychostimulant used for apathy for select patients w/ Dementia?
Methylphenidate
- ____ is the most common cause of rapidly progressive dementia
- ___ gene can test for familial susceptibility for ____ disease
- Creutzfeldt-Jakob disease
- PRNP / Prion Disease
Driving and Dementia
- Recommended to stop driving
- Most states have laws concerning dementia/driving
Dementia
- Admit all pts w/ ____ to tx underlying cause
- Refer all pts w/ new cognitive decline to ____.
- delirium
- Neurology
