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Geriatrics > Delirium > Flashcards

Delirium Flashcards

1
Q

What are the three major categories of non-cognitive (“behavioral”) sx

A

Psychotic (delusions, hallucinations)
Undesired or disruptive behavior (aggression, agitation)
Depression

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2
Q

What is the general approach for alzheimer’s dementia?

A

Try it! If it doesn’t work, try again, try something different, evaluate your approach to determine if you did a good job with implementation, you may have tried it at the wrong time or the wrong way

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3
Q

Are there any psychotropic meds that are w/o AEs in elderly patients?

A

No

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4
Q

How do we choose which psychotropic med we give to a specific patient

A

Match it to their sx

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5
Q

When do we start psychotropic meds?

A

Only when they have mod-severe symptoms

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6
Q

What is sun downing syndrome?

A

Associated with worsening cognition/behavior at night

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7
Q

What are potential causes of sun downing?

A

Fatigue
Lighting
Changes in internal clock
Difficulty separating dreams from reality

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8
Q

What can also occur with confusion in sun downing?

A

Anxiety
Aggression
Non-cooperation

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9
Q

What can sun downing lead to?

A

Pacing or wandering

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10
Q

What are the non-cognitive sx behavioral variant of FTD?

A

Behavioral disinhibition
Apathy/inertia
Loss of sympathy/empathy
Preservative, stereotyped or compulsive/ritualistic behavior

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11
Q

What are treatment options for FTD?

A

SSRIs for disinhibition-impulsivity
Low doses of trazodone or atypical antipsychotics for agitation
D/t EPS, depot forms, conventional agents, and risperidone should be avoided
Cognitive enhancers have not been found to be useful

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12
Q

What is the key feature in LBD and PD?

A

Fluctuations in attention and alertness

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13
Q

What is a diagnostic sign of LBD?

A

Severe sensitivity to neuroleptic (antipsychotic) agents

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14
Q

What is a prominent non-cognitive sx in patients w/LBD or PD?

A

Hallucinations

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15
Q

What type of medication should be avoided in patients with LBD or PD?

A

Antipsychotics

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16
Q

What do the non-cognitive sx depend on?

A

Location of lesions

17
Q

What is common in vascular dementia?

A

Depression and apathy are common
Sexual inappropriate behavior
Agitation and aggression occur as well
Use therapies that are targeted to the symptoms the patient is having

18
Q

Is there an FDA indication for antipsychotics in treating non-cognitive symptoms of dementia?

A

No

19
Q

What non-cognitive sx are antipsychotics moderately effective for?

A 
Psychosis (Hallucinations, Delusions,Suspiciousness)
Disruptive behaviors (agitation, aggression)
20
Q

What are BBW for antipsychotics?

A

Increased mortality in those with dementia

21
Q

What is an increased risk of antipsychotics?

A

QT prolongation

22
Q

What are side effects of atypical antipsychotics?

A

Hyperglycemia
Dyslipidemia
Weight gain

23
Q

EPS/Parkinsonism is a side effect of antipsychotics in what two problems?

A

LBD or dementia associated with PD

24
Q

What is a conventional antipsychotic?

A

Haloperidol

25
Q

What are the atypical antipsychotics?

A 
Olanzapine
Quetiapine
Risperidone
Aripiprazole
Ziprasidone
26
Q

What agents are preferred in Parkinson’s associated dementia?

A

Clozapine (clozaril)
Quetiapine (Seroquel)
Pimavanserin (NuPlazid)

27
Q

What is the MOA of Clozapine?

A

Blocks the DA 1 and 4 receptor subtypes (do not see EPS in this one)
Blocks serotonin type 2 receptor
Increases GABA turnover which inhibits DA neurons

28
Q

What is the MOA of quetiapine?

A

Potent 5HT2 receptor blocker and only moderate D2 blockade

Lower risk of EPS than rest

29
Q

What is Pimavanserin indicated for?

A

PD associated psychosis

30
Q

When do we avoid Pimavanserin?

A

CrCl < 30

Combination with 3A4 inhibitors/inducers

31
Q

Why does Pimavanserin not worsen motor symptoms like other atypical antipsychotics?

A

Does not block DA receptor

32
Q

What is the efficacy of anticonvulsants in non-cognitive sx of dementia?

A

minimal to modest

33
Q

What is the anticonvulsant drug used in non-cognitive sx of dementia?

A

Valproic acid 500-1200mg/d

34
Q

For what sx do benzos show efficacy in non-cognitive sx of dementia?

A

Agitation
Aggression
Anxiety

Geriatrics (15 decks)

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