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Geriatrics > Delirium + Cognitive Impairment > Flashcards

Delirium + Cognitive Impairment Flashcards

1
Q

Delirium is defined as…

A

An acute confusional state (hours-days) which affects global cognitive function

Memory, orientation, language, perception, visuospatial skills

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2
Q

Other features of delirium besides confusion includes…

A

Psychomotor disturbance
Altered sleep-wake cycle
Emotional lability

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3
Q

Delirium may ____ in severity, and is…

idiopathic? causational?

A

Fluctuate in severity, and is attributable to an underlying cause

Ex: infection

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4
Q

Prevalence of delirium is…

General prevalence common in…

A

Especially common among older adults - most common surgical complication

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5
Q

Delirium is significant because…

A

It is a poor prognostic indicator
Associated with higher rates of death, discharge to higher level care, developing dementia
Sustained functional decline 6 months after admission

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6
Q

Etiology of delirium is…

A

Underlying vulnerability + A Stressor

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7
Q

Underlying vulnerability includes…

Predisposition

A

Cognitive dysfunction
Frailty (ADL’s)
Older age
Multimorbidity

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8
Q

Stressors that may trigger delirium include…

Precipitating factors !

A

Drugs
Infection, surgery, trauma
Hypoxia
Hypoglycemia
Dehydration
Pain
Exacerbation of chronic illness (COPD, HF)

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9
Q

The worst drugs that precipitate delirium are…

3 Classes: Think of the BEERS criteria

A

Anticholinergics
BZD, Z-drugs
Opioids

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10
Q

Other drugs that increase risk precipitating delirium are…

A

Anticonvulsants
Dopamine agonists
Amantadine
Cannabis (THC-based)

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11
Q

Drugs that are less likely to precipitate delirium but still could include…

A

Corticosteroids
Psychoactive NSAID’s
Digoxin
Cannabis (CBD-based)

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12
Q

The most useful assessment method to assess for delirium is…

A

The Confusion Assessment Method (CAM)

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13
Q

CAM criteria requires…

A

Acute change in mental status with fluctuations AND inattention, with EITHER disorganized thinking or altered level of consciousness

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14
Q

Delirium can manifest as different subtypes, such as…

A

Hyperactive
Hypoactive
Or mixed

Hyperactive is much easier to recognize due to level of disruption

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15
Q

Mean duration of delirium is…

A

16 days

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16
Q

Primary outcome of delirium is…

A

Mortality

Infectious roots

17
Q

Delirium is different from dementia in multiple ways, such as…

A

ACUTE onset with fluctuating course (not progressive)
Consciousness may be altered, with impaired attention + hallucinations

18
Q

Strategies for delirium prevention include…

A

Orientation
Mobilization
Medication Review
Optimize hydration + nutrition

Examples of orientation = calendars, providing stimulation, regular sleep-wake cycle

19
Q

1st line care for a delirium patient is to ____, and role of pharmacist is to…

A

Identify + manage underlying causes; we can look at proper infection treatment and medication induced cases.

20
Q

Supportive care should be provided to delirium patients. This includes…

A

Treating underlying condition; manging pain + other symptoms
Encourage mobilization
Re-orientation, cues
Maintain sleep-wake schedule
De-escalation for agitated individuals

21
Q

Pharmacological treatment for delirium should only be considered if…

A

The patient is in significant distress from their symptoms, poses a safety risk to themselves or others, or impeding essential aspects of medical care

This is OFF-LABEL

22
Q

If medications are used, 1st line agents for delirium are…

A

Antipsychotics

23
Q

For delirium, efficacy of antipsychotics is…

A

Similar; choose based on AE profile, patient factors, and availability

Start low dose + titrate to effect q30m; PRN doses after

24
Q

These drugs should be avoided in delirium, even if patient presents with anxiety/distress…

A

Benzodiazepines

25
Q

Cases where benzodiazepines could be used in delirium include…

A

Alcohol-withdrawal delirium, terminal delirium, and if patient had baseline BZD

Baseline BZD = cannot stop

26
Q

The conventional AP of choice is ____, but if longer treatment duration is required…

A

Haloperidol - longer tx duration = switch to atypical to lower risk of EPS

27
Q

Atypical AP’s lower risk of ____ but increase risk for ____

A

EPS; orthostatic hypotension

DOES increase fall risk

28
Q

The most anticholinergic atypical AP is ____ so it should be avoided.

A

Olanzapine

29
Q

Quetiapine is the agent of choice for patients with ____ or ____, because…

A

Parkinson’s or Lewy Body Dementia; least dopamine blocking activity, better tolerated for movement issues

30
Q

Antipsychotics do NOT speed up ____ and do not prevent ____

A

Recovery of delirium - do not prevent future episodes

31
Q

Overall, the role of the pharmacist in delirium management is to…

A

Deprescribe medications known to increase delirium risk
Assess for + manage pain, constipation
Ensure proper usage of antipsychotics

Geriatrics (8 decks)

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