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BR 3rd Ed > Ch 2 - TBI: Posttraumatic Agitation > Flashcards

Ch 2 - TBI: Posttraumatic Agitation Flashcards

1
Q

What is posttraumatic agitation?

A

Subtype of delirium occurring during the state of posttraumatic amnesia

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2
Q

What are characteristics of posttraumatic agitation?

A

Aggression
Akathisia
Disinhibition
Emotional lability

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3
Q

How long does posttraumatic agitation typically last?

A

1 to 14 days but can last longer

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4
Q

What types of lesions MC have posttraumatic agitation?

A

Frontotemporal lesions, which coordinate arousal, attention, executive control, memory, and limbic behavioral functions

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5
Q

What are ways to quantify agitation?

A

Agitated Behavior Scale (ABS) or Overt Aggression Scale

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6
Q

What is the Agitated Behavior Scale (ABS)?

A

Serial assessments of agitated patients based on observation during an 8 hour nursing shift or after therapy treatment

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7
Q

How is the patient rated in Agitated Behavior Scale (ABS)?

A

14 items or behaviors rated b/w 1 (absent) to 4 (present to an extreme)

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8
Q

What is the total scoring in Agitated Behavior Scale (ABS)?

A

Below 21: normal
22 to 28: mild agitation
29 to 35: moderate agitation
35 to 54: severe agitation

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9
Q

Describe ways to reduce the level of stimulation in the environment for an agitated patient

A 
Quiet private room
Remove noxious stim
Staff to behave calm
Limit sounds/visitors
Limit # and length of therapy sessions 
Do therapy in pts room
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10
Q

Describe ways to protect patient from harming self or others.

A

Sitter for safety
Place in locked ward
Avoiding taking patient off floor
Craig bed (flood bed with padded walls)

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11
Q

Describe ways to reduce patient’s cognitive confusion.

A

One person speak to pt at a time
Maintain similar staff
Communicate briefly and simply with one idea at a time

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12
Q

Describe ways to tolerate restlessness.

A

Allow patient to thrash on floor bed
Allow pacing around with supervision
Allow confused patient to be verbally inappropriate

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13
Q

What complication can antipsychotic medications cause?

A

Neuroleptic malignant syndrome (fever, leukocytosis, muscle stiffness)

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14
Q

How is neuroleptic malignant syndrome treated?

A

Dantrolene and beta-blockers

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15
Q

What is the MOA of typical antipsychotic agents?

A

Block D2-receptors, histaminic, alpha-1-adrenergic and cholinergic receptors

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16
Q

What do antipsychotic agents with more anticholinergic properties due to the nigrostriatal pathway?

A

Inc dopamine lessening extrapyramidal symptoms (EPS)

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17
Q

What has been shown in animal models and humans with the use of haloperiodol?

A

Animals: slow motor recovery
Humans: prolong PTA

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18
Q

What are types of typical antipsychotics?

A

Haldoperidol
Chlorpromazine
Thiothixene

19
Q

What is the MOA of atypical antipsychotic agents?

A

Less blockage of dopamine D2-receptors with more serotonin blockade at 5HT2-receptor

20
Q

What are atypical antipsychotics less likely to cause?

A

Tardive dyskinesia
Parkinsonism
Dystonia
Akasthisia

21
Q

What are side effects of atypical antipsychotics?

A 
Hyperglycemia/DM
Weight gain
HLD
Stroke
QT prolongation
22
Q

What types of atypical antipsychotics?

A 
Risperidone (Risperdal)
Ziprasidone (Geodon)
Quetiapine (Seroquel)
Olanzapine (Zyprexa)
Clozapine (Clozaril)
Aripiprazole (Abilify)
23
Q

Which medication is the most “typical” of the atypical antipsychotics?

A

Risperidone (Risperdal) at higher doses, higher incidence of EPS than other atypicals

24
Q

What are side effects of Risperidone (Risperdal)?

A 
Stimulating
Insomnia
Agitation
Hypotension
Inc prolactin levels
25
Q

What is the MC side effect of Ziprasidone (Geodon)?

A

Most known for QT prolongation; otherwise, favorable side-effects profile

26
Q

What is the MC side effect of Quetiapine (Seroquel)?

A

Very sedating

27
Q

What are side effects of Olanzapine (Zyprexa)?

A

Somnolence
Gait disturbances
High right of metabolic SE and weight gain
Dose related EPS (>7.5 mg)

28
Q

What are side effects of Clozapine (Clozaril)?

A

Agranulocytosis
Cardiac effects
Lowered seizure threshold
Most anticholinergic activity and weight gain of all atypicals

29
Q

What are side effects of Aripiprazole (Abilify)?

A

Least sedating
Fewest EPS
Low propensity for metabolic adverse reaction

30
Q

What are side effects of benzodiazepines?

A 
Paradoxal agitation in elderly
Inc confusion in emerging PTA
Respiratory depression
Disinhibition
Impaired coordination
31
Q

What can benzodiazepines be used to treat in TBI patients?

A

Mutism

32
Q

Which agents have the best evidence for efficacy in treating posttraumatic agitation?

A

Beta-blockers

33
Q

Which beta-blockers are the most effective for posttraumatic agitation?

A

Lipophilic agents (propranolol, metoprolol)

34
Q

What can Valproic acid (Depakote, Depakene) be helpful for?

A

Reduce behavioral outbursts and agitation

35
Q

What can Carbamazepine (Tegretol), oxcarbazepine (Trileptal) be helpful for?

A

Can improve irritability, disinhibition, and aggression

36
Q

What have been found to be reduced in CSF of agitated anoxic brain injury (ABI) patients?

A

Metabolites of norepinephrine and serotonin

37
Q

What have Amitriptyline and desipramine been shown to reduce?

A

Reduce agitation and aggressive behaviors possibly due to sedative effects.

38
Q

What has Sertraline been shown to reduce?

A

Reduce irritability and aggressive behavior

39
Q

What has Trazodone been shown to reduce?

A

Reduce agitation and aggressive behaviors in dementia patients

40
Q

What has Buspirone been shown to reduce?

A

Reduced aggressive behavior

41
Q

What has Buproprion been shown to reduce?

A

Restlessness

42
Q

When can Lithium be useful in TBI?

A

Aggression is related to manic effects and irritability is related to cyclic mood disorders

43
Q

What is Medroxyprogesterone acetate (Depo-Provera) used for in TBI?

A

For aggressive hypersexual behavior—lowers testosterone

BR 3rd Ed (92 decks)

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