Delirium + Cognitive Impairment Flashcards
Delirium is defined as…
An acute confusional state (hours-days) which affects global cognitive function
Memory, orientation, language, perception, visuospatial skills
Other features of delirium besides confusion includes…
Psychomotor disturbance
Altered sleep-wake cycle
Emotional lability
Delirium may ____ in severity, and is…
idiopathic? causational?
Fluctuate in severity, and is attributable to an underlying cause
Ex: infection
Prevalence of delirium is…
General prevalence common in…
Especially common among older adults - most common surgical complication
Delirium is significant because…
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
Etiology of delirium is…
Underlying vulnerability + A Stressor
Underlying vulnerability includes…
Predisposition
Cognitive dysfunction
Frailty (ADL’s)
Older age
Multimorbidity
Stressors that may trigger delirium include…
Precipitating factors !
Drugs
Infection, surgery, trauma
Hypoxia
Hypoglycemia
Dehydration
Pain
Exacerbation of chronic illness (COPD, HF)
The worst drugs that precipitate delirium are…
3 Classes: Think of the BEERS criteria
Anticholinergics
BZD, Z-drugs
Opioids
Other drugs that increase risk precipitating delirium are…
Anticonvulsants
Dopamine agonists
Amantadine
Cannabis (THC-based)
Drugs that are less likely to precipitate delirium but still could include…
Corticosteroids
Psychoactive NSAID’s
Digoxin
Cannabis (CBD-based)
The most useful assessment method to assess for delirium is…
The Confusion Assessment Method (CAM)
CAM criteria requires…
Acute change in mental status with fluctuations AND inattention, with EITHER disorganized thinking or altered level of consciousness
Delirium can manifest as different subtypes, such as…
Hyperactive
Hypoactive
Or mixed
Hyperactive is much easier to recognize due to level of disruption
Mean duration of delirium is…
16 days
Primary outcome of delirium is…
Mortality
Infectious roots
Delirium is different from dementia in multiple ways, such as…
ACUTE onset with fluctuating course (not progressive)
Consciousness may be altered, with impaired attention + hallucinations
Strategies for delirium prevention include…
Orientation
Mobilization
Medication Review
Optimize hydration + nutrition
Examples of orientation = calendars, providing stimulation, regular sleep-wake cycle
1st line care for a delirium patient is to ____, and role of pharmacist is to…
Identify + manage underlying causes; we can look at proper infection treatment and medication induced cases.
Supportive care should be provided to delirium patients. This includes…
Treating underlying condition; manging pain + other symptoms
Encourage mobilization
Re-orientation, cues
Maintain sleep-wake schedule
De-escalation for agitated individuals
Pharmacological treatment for delirium should only be considered if…
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
If medications are used, 1st line agents for delirium are…
Antipsychotics
For delirium, efficacy of antipsychotics is…
Similar; choose based on AE profile, patient factors, and availability
Start low dose + titrate to effect q30m; PRN doses after
These drugs should be avoided in delirium, even if patient presents with anxiety/distress…
Benzodiazepines
Cases where benzodiazepines could be used in delirium include…
Alcohol-withdrawal delirium, terminal delirium, and if patient had baseline BZD
Baseline BZD = cannot stop
The conventional AP of choice is ____, but if longer treatment duration is required…
Haloperidol - longer tx duration = switch to atypical to lower risk of EPS
Atypical AP’s lower risk of ____ but increase risk for ____
EPS; orthostatic hypotension
DOES increase fall risk
The most anticholinergic atypical AP is ____ so it should be avoided.
Olanzapine
Quetiapine is the agent of choice for patients with ____ or ____, because…
Parkinson’s or Lewy Body Dementia; least dopamine blocking activity, better tolerated for movement issues
Antipsychotics do NOT speed up ____ and do not prevent ____
Recovery of delirium - do not prevent future episodes
Overall, the role of the pharmacist in delirium management is to…
Deprescribe medications known to increase delirium risk
Assess for + manage pain, constipation
Ensure proper usage of antipsychotics
