Delerium Flashcards
What is delirium?
Acute confusional state
What does delirium affect?
Global cognitive state
inclusive of memory, orientation, language, perception, and visuospatial skills
What are some other features of delirium?
Psychomotor disturbances
Altered sleep-wake cycle
Emotional lability
What is the DSM-5 for delirium?
What is the prevalence of delirium?
11-42% of medical inpatients
What is delirium especially common in?
older adults >70 years of age
What is delirium associated with? (3 points)
2x increase death
2.5 increase risk of discharge ot higher level of care
12.5x risk of developing dementia
What can delirium lead to with regards to hospitalization
Increased length of stay
What are the stressors of delirium?
What predisposes someone of delirium?
What may precipitate delirium?
What is the scale used bedside for delirium?
Confusion assessment method (CAM)
What are the different types of delirium?
Hyperactive, mixed, hypoactive
What are the requirements for CAM score?
What is the prognosis of delirium?
With regards to the onset what is the difference between delirium and dementia?
Delirium= acute
Dementia= chronic
With regards to the course what is the difference between delirium and dementia?
Delirium= fluctuating
Dementia= slowly progressive
With regards to the decreased level on consciousness what is the difference between delirium and dementia?
Delirium= may be present
Dementia= absent
With regards to the attention what is the difference between delirium and dementia?
Delirium= impaired
Dementia= preserved until end-stage
With regards to the hallucinations what is the difference between delirium and dementia?
Delirium= common
Dementia= rare until later stages*
*Exception is Lewy body dementia
What is the order of delirium management? (3)
Identify and manage the undrlying causes
Initiate or continue supportive strategies
Medication (Only if necessary)
When would we provide pharmacological care?
Patient is in significant distress form their symptoms
Patient poses a safety risk to self or others
Patient is impeding essential aspects of medical care
WHat are the off label managements for delirium management?
APS
What is the decision process for choosing an APS?
Side effect profile. patient factors, availability
Low dose and tritrate to effect Q30 minutes
What drug class should be avoided with delirium?
Benzodiazepines
- Except in alcohol-withdrawal delirium, terminal dlirium
What is the conventional drug of choice for the treatment of delirium?
Haloperiodol as it is available in oral nad parenteral formulations
What is the issue with using atypical or second generation APS?
Decreased risk of PES, but increased risk of orthostatic hypotension
Which of the atypical APS have the highest anticholinergic effects?
Olanzapine.
What is the agent of choice for individuals with parkinson’s disease or lewy body disease?
Quetiapine
What blackbox warning to APS have?
Warning for use in individuals with dementia
What is the risk of using APS in dementia?
Increase risk of mortality, and not seen in studies of short term use for delirium
What is the role of the pharmacist with regards to delirium management?
Deprescribe agents known to increase delirium risk
Assess for and manage pain, constipation, ensure judicious use of APS for delirium
Esnure appropriate use of APS for delirium (Started and taken off in hospital)
