IC3 Geriatric Syndrome Flashcards
MOA of betahistine
Type 3 Histamine Receptor antagonist; Partial agonist at H1 receptor; negligible agonism at H2 receptor
Caution / Contraindication for betahistine
- Caution in Asthma (may act on histamine receptor & cause bronchospasm)
- C/I in active or Hx of Peptic Ulcer Disease
Key treatment for dizziness due to stroke (dysequilibrium)
Vestibular rehabilitation
Symptoms of Hyperactive delirium
- Agitation
- Inattention
- Psychosis (hallucination/ delusions)
Sx of hypoactive delirium
- Slow response
- Incr sedation
Risk factors for Delirium
- 65y/o and above
- Cognitive impairment (Past/Present) and/or Dementia
- Current hip fracture
- Severe illness
Detection tool used for delirium
4AT:
- Level of Alertness
- Abbreviated Mental Test 4 [DOB, Age, Place, Current Year]
- Attention [Dec>Nov>…] vs [30 -3 -3 -3 -3….]
- Acuity
Common etiology of delirium
I WATCH DEATH:
- Infection
- Withdrawal (alcohol, benzo, barbiturates)
- Acute metabolic disorder
- Trauma
- CNS pathology
- Hypoxia
- Deficiencies (B12, folic acid, thiamine)
- Endocrinopathies
- Acute vascular
- Toxins
- Heavy metals
H2 receptor antagonist: is it anticholinergic?
Yes
Which H2RA is the most and least anticholinergic?
Most: Cimetidine
Least: Famotidine
Drug classes that incr delirium risk
- Anticholinergics
- Benzodiazepines
- Z-drugs
- Opioids (esp pethidine)
- H2RA
- Antimicrobials (FQ, cefepime)
- Steroids
- Dopamine agonist
- Anticonvulsants (levetiracetam)
- Antidepressants (mirtazapine, SSRI, TCA)
- Cardiovascular (Digoxin)
- Lithium
Things to watch out for during Medication review to prevent delirium
Abrupt withdrawal, psychoactive drugs, drugs causing delirium
4 types of urinary incontinence
Stress, Urge, Overflow, Functional
