MFE Flashcards
Causes of delirium
DELIRIUMS
Drugs and Alcohol (Anti-cholinergics, opiates, anti-convulsants, recreational)
Eyes, ears and emotional disturbances
Low Output state (cardio, resp)
Infection
Retention
Ictal (seizure activity)
Under-hydration/Under-nutrition
Metabolic disorders
Subdural hematoma, sleep deprivation
Define Orthostatic hypotension
Decrease in systolic blood pressure of 20 mmHg or a decrease in diastolic blood pressure of 10 mmHg within three minutes of standing when compared with blood pressure from the sitting or supine position.
Lilliputian hallucination refers to the delusion of seeing tiny people / creatures
Alcohol withdrawal syndrome
Constipation is a common cause of delirium in elderly inpatients, particularly in those taking _________ analgesia
Opiate
There is likely a deprivation of liberty if..
The person is subject to continuous supervision and control and
The person is not free to leave
Which drugs cause constipation?
Opiates, calcium channel blockers and some antipsychotics
Medications for pain
Morphine
Diamorphine
Oxycodone
Alfentanyl (for those with renal failure)
Medications for breathlessness
Therapeutic oxygen
Morphine
Midazolam
Medications for nausea and vomiting
Levomepromazine
Cyclizine
Haloperidol
Metoclopramide
Medications for restlessness and confusion
Haloperidol
Levomepromazine
Midazolam
Medications for respiratory tract secretions
Hyoscine hydrobromide/butylbromide
Glycopyrronium
Which drug classes cause delirium?
Anti-cholinergics, opiates, anti-convulsants, recreational
Mx for constipation
Exclusion of underlying causes - colorectal cancer
Lifestyle modifications - increase dietary fibre, adequate fluid intake, adequate activity levels
First-line laxative: bulk-forming laxative first-line, such as ispaghula
Second-line: osmotic laxative, such as a macrogol
A 67 year old man was electively admitted for a total hip replacement. On the third day postoperatively he is reviewed on the ward.
He is acutely confused with impaired concentration, agitation, tremor, sweating and tachycardia. He swats at his bed clothes as though trying to kill insects.
What is the underlying cause of his delirium?
Alcohol withdrawal - lilliputian hallucination refers to the delusion of seeing tiny people / creatures. This can be a sign of delirium tremens due to alcohol withdrawal
Seizure threshold lowering drugs
Antibiotics: Imipenem, penicillins, cephalosporins, metronidazole, isoniazid
Antipsychotics
Antidepressents: Bupropion, Tricyclics, Venlafaxine
Tramadol
Fentanyl
Ketamine
Lidocaine
Lithium
Antihistamines
Dementia alongside two of the three features: fluctuating attention and concentration, recurrent well-formed visual hallucinations, spontaneous Parkinsonism
LBD
Breakthrough pain medication is calculated as…
Sixth of the total daily dose
Medications that cause postural hypotension
Nancy Doesn’t Always Bring Lollipops And Apples
Nitrates
Diuretics
Anticholinergics
Beta-blockers
L-Dopa
Antidepressants
ACE inhibitors
Medications associated with falls due to other mechanisms
BAAC DOO
Benzodiazepines
Antipsychotics
Anticonvulsants
Codeine
Digoxin
Opiates
Other sedatives
Gastrointestinal disturbance (nausea, vomiting, abdominal pain), dizziness, confusion, blurry or yellow vision, and arrhythmias.
Acute digoxin toxicity
Dry eyes, dry mouth, hypotension (often postural) and delirium
Side-effects of an anticholinergic drug such like amitriptyline
If there is a bleeding ulcer, stop _______
NSAIDs
If there is kidney failure, stop _______
ACE inhibitor
If there is severe hyponatraemia, stop _______
Antidepressant
ACE-i and CCB cause..
Postural hypotension
Thiazides can cause..
Dehydration
Amitriptyline can cause..
Anti-cholinergic side effects