Medications

Question 1

Medications linked to delirium

Answer 1

Medications are the most common reversible cause of delirium and dementia in the elderly. Many medications can cause cognitive impairment but the classes of drugs most often associated with the development of drug-induced dementia are benzodiazepines and anticholinergics.

Long acting benzodiazepines (e.g. diazepam) are more troublesome than those which are shorter acting.

The following medications have high anticholinergic activity:

Tertiary amine tricyclics (e.g. amitriptyline, imipramine, and doxepine).
First generation H1 antihistamines (e.g. hydroxyzine, promethazine, and chlorpheniramine). Adverse drug reactions are most commonly associated with the first generation H1 antihistamine due to their relative lack of selectivity for the H1-receptor and their ability to cross the blood-brain barrier. Second-generation H1 antihistamines are much more selective for peripheral H1 receptors as opposed to the central nervous system H1 receptors and cholinergic receptors (examples include loratadine and cetirizine).
Anticholinergic antiparkinson agents (e.g. benztropine, orphenadrine, and trihexyphenidyl).
Mydriatics (e.g. atropine, tropicamide).
Antipsychotics (e.g. chlorpromazine and clozapine)

Question 2

Medications linked to mood changes

Answer 2

The following medications are well known to precipitate mood changes:

Centrally-acting antihypertensives (e.g. methyldopa, reserpine, and clonidine) can cause depressive symptoms.
Interferon-a is capable of inducing depressive symptoms.
Digoxin is capable of inducing depressive symptoms.
Corticosteroids can cause depressive, manic, and mixed symptoms with or without psychosis.
Antidepressants can precipitate mania.

Question 3

Medications linked to psychosis

Answer 3

The following medications are well known to precipitate psychosis:

Anti-Parkinsons Medications (e.g. bromocriptine, amantadine, selegiline, anticholinergics (e.g. trihexyphenidyl, benztropine, benzhexol), and levodopa).
Corticosteroids

Question 4

Medications linked to anxiety

Answer 4

The following medications are well known to precipitate anxiety:

Stimulants
β adrenergic inhalers