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BCPS Exam > Critical Care: Delirium > Flashcards

Critical Care: Delirium Flashcards

1
Q

Define delirium

A

An acute change in cognitive function

2. characterized by disorganized thought, altered level of consciousness, and inattentiveness

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2
Q

List three adverse outcomes of delirium

A
  1. increased mortality
  2. prolonged length of stay in the ICU
  3. cognitive impairment after ICU discharge
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3
Q

List two assessment tools for delirium

A
  1. Confusion Assessment Method for the ICU (CAM-ICU)

2. Intensive Care Delirium Screening Checklist (ICDSC)

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4
Q

What is the utility of CAM-ICU

A

the CAM-ICU is designed to detect delirium at the time of testing

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5
Q

What is the utility of ICDSC

A

the ICDSC detects delirium during a nursing shift

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6
Q

List nine nonpharmacologic interventions for delirium

A
  1. maintain communication with patient
  2. reorient patient (person, place, time)
  3. maximizing uninterrupted sleep
  4. provide access to natural lighting
  5. remove unnecessary equipment from room
  6. correct sensory deficits
  7. remove unneeded invasive devices
  8. minimizing physical restraint
  9. encouraging patient autonomy and early mobility
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7
Q

List three ways to maximize uninterrupted sleep

A
  1. control light and noise
  2. cluster patient care activities
  3. decrease stimuli at night
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8
Q

List two ways to correct sensory deficits

A
  1. hearing aids

2. glasses

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9
Q

List four potentially unneeded invasive devices

A
  1. urinary catheters
  2. intravenous lines
  3. endotracheal tubes
  4. enteral feeding tubes
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10
Q

List three correctable causes of delirium

A
  1. hypotension
  2. hypoxia
  3. electrolyte disturbances
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11
Q

When should antipsychotics be used in the treatment of delirium?

A
  1. Guidelines discourage routine use

2. Should be considered when patients experience significant distress because of symptoms of delirium

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12
Q

What is the role of antipsychotics in delirium

A

Should be used as a short treatment until symptoms resolve

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13
Q

List five medications used to treat delirium

A
  1. Haloperidol
  2. Quetiapine
  3. Olanzapine
  4. Risperidone
  5. Ziprasidone
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14
Q

Describe dosing of haloperidol

A
  1. Initial dose of 2.5 mg every 6 hours (1-2.5 mg for older adult)
  2. Double every 20 minutes until an effective dose is reached
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15
Q

Describe dosing of quetiapine

A
  1. Initial dose of 2.5 mg twice daily

2. Can be quickly titrated

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16
Q

Describe dosing of olanzapine

A
  1. Initial dose 5 mg daily
17
Q

Describe dosing of risperidone

A
  1. Initial dose 0.5 mg twie daily
18
Q

Describe dosing of ziprasidone

A
  1. Initial dose 20 mg twice daily
19
Q

Which medications can reduce duration of delirium in critical care patients?

A
  1. Not haloperidol

2. 2GA

20
Q

Common critical care adverse effects of delirium medications (not all)

A
  1. QTc prolongation
  2. EPS
  3. Sedation
21
Q

Which medications for delirium are PO

A
  1. Haloperidol (atblet)
  2. Quetiapine (tablet)
  3. Olanzapine (tablet, ODT)
  4. Risperidone (tablet, ODT, solution)
  5. Ziprasidone (capsule)
22
Q

Which medications for delirium are IM

A
  1. Haloperidol (IM)
  2. Olanzapine (IM)
  3. Risperidone (IM)
  4. Ziprasidone (IM)
  5. NOT Quetiapine
23
Q

Which medications for delirium are IV

A
  1. Haloperidol (IV)
24
Q

What are available routes for haloperidol

A
  1. PO (tablet)
  2. IM
  3. IV
25
Q

What are available routes for quetiapine

A
  1. PO (tablet)
26
Q

What are available routes for olanzapine

A
  1. PO (tablet, ODT)

2. IM

27
Q

What are available routes risperidone

A
  1. PO (tablet, ODT, solution)

2. IM

28
Q

What are available routes for ziprasidone

A
  1. PO (capsule)

2. IM

29
Q

What is monitoring for haloperidol?

A
  1. Hypotension
  2. QTc interval at baseline and daily
  3. Extrapyramidal effects
30
Q

Difference between haloperidol vs 2GA?

A
  1. 2GA reduce duration of delirium

2. 2GA lower risk of EPS

31
Q

What are the differences between 2GA?

A
  1. Half-life (how quickly can be titrated)
  2. Risk of QTc prolongation
  3. Sedation
  4. Risk of EPS
32
Q

Compare sedation between antipsychotics

A
  1. Haloperidol (least)
  2. Ziprasidone
  3. Risperidone (initially)
  4. Olanzapine = Quetiapine
33
Q

Compare anticholinergic effects between antipsychotics

A
  1. Risperidone (least)
  2. Haloperidol = Ziprasidone
  3. Quetiapine
  4. Olanzapine
34
Q

What is the benefit of shorter half-life antipsychotics?

A

can be titrated faster

35
Q

Rank the half-life of antipsychotics

A
  1. Quetiapine (6 hours)
  2. Ziprasidone (7 hours)
  3. Haloperidol (18 hours)
  4. Risperidone (24 hours)
  5. Olanzapine (33 hours)
36
Q

Which antipsychotics have a lower risk of QT prolongation?

A
  1. Olanzapine

2. Risperidone

37
Q

How does hyperactive vs. hypoactive delirium help with selection of antipsychotic?

A

Sedation may be beneficial in hyperactive delirium

BCPS Exam (34 decks)

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