Geriatrics - Dementia-Related Psychosis and Agitation Flashcards
Explain the psychobehavioral metaphor and its relevance?
the most salient symptomatic cluster, helps select medication in class relevant to metaphor
Explain the DICE approach?
Describe problematic behavior, investigate possible causes, create and implement plan, evaluate response for safety and efficacy
List the neuropsychiatric symptoms (NPS) in dementia?
hallucinations, delusions, agitation, aggression, apathy, depression, anxiety, sleep disorders
What is a BBW for all antipsychotics?
increased risk of death in elderly patients with dementia
Rank the mortality risk for antipsychotics in elderly with dementia?
quetiapine < risperidone < haloperidol
What is treatment for agitation associated with dementia due to Alzheimer’s disease?
brexpiprazole (Rexulti)
What are AEs of brexpiprazole (Rexulti)?
HA, UTI, nasopharyngitis, sleep disturbances
What are treatments for behavior in Parkinson’s disease? (3)
quetiapine, olanzapine, pimavanserin (Nuplazid)
Which antidepressants have significant anticholinergic effects especially in elderly? (3)
paroxetine, desipramine, nortriptyline
What is treatment for depression with insomnia and weight loss in elderly?
mirtazapine
What is treatment when sedation is desired in elderly?
trazodone
What are treatments for apathy in elderly? (3)
methylphenidate, dextroamphetamine, modafinil
What are treatments for manic-like states in elderly? (4)
divalproex sodium, lithium, lamotrigine, carbamazepine
What are non-pharm treatments for agitation or aggression in elderly?
exclude underlying physical discomfort (e.g., pain/hunger), identify behavioral antecedents and avoid triggers, positive reinforcement, physical restraint (LAST-LINE)
What are treatments for anxiety in elderly? (2)
busprione, trazodone
