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Residency > Pharm of Acute Agitation > Flashcards

Pharm of Acute Agitation Flashcards

1
Q

What are the non-antipsychotic options to manage acute agitation?

A

Benzos and ketamine

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2
Q

Pros and cons of benzos for agitation

A

Good for patient’s with no known medical history, or if intoxicated (except for ETOH)
No cardiotoxic effects
Don’t decrease seizure threshhold
Must monitor for cardio/respiratory depression

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3
Q

What are the different benzos used for agitation and the differences between them?

A

Midazolam: faster on/off
Lorazepam: slower on, but longer lasting
Diazepam: has active metabolites making oversedation a risk with repeat doses

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4
Q

What is the dosing for midazolam and the routes of administration and onset of action?

A

2-5mg
IV 3-5min
IM 10-20min
PO 10-30min

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5
Q

What is the dosing, routes of administration and onset for lorazepam?

A

0.5-4mg
IV 5-10 min
IM 15-30 min
PO 20-30 min

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6
Q

How do the half lives compare between lorazepam and midazolam?

A

Ativan: 10-14 hours
Versed: 1-4hrs

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7
Q

When should ketamine be avoided?

A

schizophrenia and primary psychosis

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8
Q

What is the dosing and routes and time of onset for ketamine in agitation?

A

IV/IO 1-2mg/kg, onset <30sec

IM 4-5mg/kg, onset 3-5min

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9
Q

What are the pros and cons of haloperidol in agitation?

A

Low sedation/hypotension
Sedation only at 2 hrs
Increased QTc and dystonic reactions requiring co-administration of other drugs

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10
Q

What drugs can be given to mediate the dystonic reaction of haloperidol?

A

Promethazine
Benztropine
Diphenhydramine

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11
Q

What is the onset of action for haloperidol?

A

20-40 minutes IM

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12
Q

What is the dosing for haloperidol?

A

2-5mg IM q4-8hrs PRN, but may need q1Hr administration

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13
Q

What patients should not be given haloperidol for agitation?

A

Dementia-related psychosis
Increased risk of death
Contraindicated in parkinsons

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14
Q

Should IV haloperidol be given?

A

IV administration carries higher risk of QT prolongation and must be monitored by EKG

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15
Q

2nd generation anti-psychotics are drugs of choice for what patients?

A

Underlying psychiatric illness now experiencing agitation

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16
Q

How do second generation anti-psychotics compare to first generation?

A

Same efficacy with less side-effects

Still cause prolonged QTc, but less likely to be greater than 500

17
Q

How do the 2nd gen anti psych drugs compare with QTc?

A

Ziprasidone is worst for QTc and Olanzapine is best

18
Q

What is the dosing for Geodon and route?

A

10-20mg IM
Q2h if 10mg
Q4h if 20mg

19
Q

What is the dosing and route for Zyprexa?

A

5-10mg IM/PO q2-4h

20
Q

How does onset of action compare between 1st and second gen anti psychotics?

A

1st gen: onset 30-60 minutes IM

2nd gen: onset 15-45 min IM

21
Q

How does duration of action compare between haloperidol, geodon and zyprexa?

A

Haldol: 18hr t1/2
Geodon: 2-5hr
Zyprexa: 21-54hr

22
Q

What is the drug of choice for agitation and ETOH intoxication?

A

Haldol

23
Q

Which anti-psychotic works the most often to decrease psychosis and agitation?

A

Ziprasidone

24
Q

When is onset for haldol faster than olanzapine?

A

Haldol + promethazine is faster onset

25
Q

How does midazolam compare to haldol overall?

A

Versed is faster and has the same long-term outcomes overall

26
Q

What caution should be considered when treating elderly agitated patient?

A

Rapid respiratory depression and decompensation is possible in the elderly and they are easily over sedated
Increase risk of CVA with anti-psychotics

27
Q

What caution should be remembered with combining olanzapine with other agitation medications?

A

zyprexa + benzos leads to excessive sedation and cardiorespiratory depression making monitoring required and use in elderly contraindicated

28
Q

Which anti-psychotic is ok in elderly with dementia and parkinsons?

A

Ziprasidone

29
Q

What are first-line agents in elderly agitated patients? Second line?

A

Geodon, then haldol but at a reduced dose and with more gradual adjustments

30
Q

What drugs should be avoided in elderly?

A

Benzos, diphenhydramine, cogentin and anti-cholinergics which can cause extra-pyramidal symptoms.

Residency (19 decks)

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