Geriatric Psych Flashcards
TCA that is least likely to cause orthostatic hypotension in elderly
nortriptyline (other triptylines too)
also used for chronic pain, migraine
minimum workup for reversible causes of dementia
CBC, electrolytes, TFTs, B12, folate, RPR, CT or MRI
exam for mental status
MMSE, SLUMS
NMDA R antagonist approved for AD Rx
memantine
SE: dizziness
donepezil, galantamine, rivastigmine
CholE inhibitors
caution if brady, GI bleed, sz, asthma, COPD
only symptomatic benefit
increase cholinergic tone in basal forebrain for memory and attention
late onset dementia a/f onset of rigidity, bradykinesia, resting tremor
PD
antipsychotic least likely to cause EPS
quetiapine, clozapine (risk of agranulocytosis, need weekly blood tests)
black box warning on what class of meds for increased mortality risk in the elderly with dementia due to 1.7x increase deaths due to CV or infectious events
antipsychotics
long term med SE more common in elderly women, choreoathetoid (writhing) mvmts of mouth and tongue, also more in substance use in patients who use med for at least 6 months
antipsychotics, tardive dyskinesia, switch to other antipsychotic
EPS SE of antipsychotics
akathisia (quickly), tremors, bradykinesia, TD
TCA with least sedating, least anticholinergic SE
desipramine, best for patients with BPD to avoid urinary retention
a/f death of loved one, feel guilt, sadness, sleep disturbance, weight loss, senses deceased person’s presence and once heard voice, attempts to return to normal activities, no SI, resolves in one year
normal grief
insomnia rx most likely to cause amnestic cognitive impairment in geriatric patients; also at increased risk of delirium, falls, fractures, MVA (avoid non-bzd bzra’s also avoided in pts with hx of falls or fractures)
temazepam (benzos in general)
with increased age, same total time of this stage of sleep but shorter duration and increased latency
REM
med commonly used for night terrors
prazosin
