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Geriatrics > Psych and pharmacology > Flashcards

Psych and pharmacology Flashcards

1
Q

True or false: most patients with dementia will have some major psych/behavioral difficulty

A

True

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2
Q

Which usually causes more suffering for pts and families: the cognitive decline associated with dementia, or the psych problems that come with it?

A

The psych problems

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3
Q

When a pt with dementia develops new symptomatology, why must this be evaluated carefully?

A

Pts have problems communicating what they are experiencing

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4
Q

What is the first step to evaluating a psych problem?

A

H&P

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5
Q

Why is the PE important in a psych exam?

A

often with these patients their only expression of a physical ailment may be a change in mental status

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6
Q

True or false: the dementias mneonic is useful for evaluating psych diagnoses

A

True

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7
Q

All psych diagnoses demand consideration of what?

A

for the intervention regarding the triggering events, environment, caregiver stress,

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8
Q

What is agitation?

A

non-specific umbrella term for many behavoirs and symptoms

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9
Q

Why is it important to get the most specific description of agitation?

A

To get effective treatment

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10
Q

What are the non-pharmacological treatments for agitation? (4)

A

Routine
Remove environmental triggers
Quiet environment
Address pain

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11
Q

What are the pharmacologic interventions for agitation? (6)

A
  1. Buspar
  2. SSRIs
  3. Anticonvulsants
  4. Benzos
  5. Antipsychs
  6. Cholinesterase inhibitors
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12
Q

What are benzos?

A

Anticonvulsants
Antipsychotic
Anxiolytics

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13
Q

What are the problems with Benzos?

A

Increase falling and are sedative

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14
Q

What is the MOA of old antipsychotics?

A

Block D2 receptors (dopamine)

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15
Q

What are the dangers of antipsychotics?

A

Sudden death

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16
Q

What is sundowning?

A

Agitation in which the pt has symptoms in ithe afternoon or late evening

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17
Q

What are the treatments for sundowning?

A

Routine
Remove environmental triggers
Quiet environment
Address pain

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18
Q

When should medication be given for sundowners?

A

30-60 minutes prior to onset of symptoms

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19
Q

How can lighting be used to minimize the effect of sundowning?

A

Gradual decrease in light

20
Q

What are the meds that can be used for sundowning?

A

Trazadone
Benzos
Antipsychotics

21
Q

What are delusions?

A

False beliefs that are usually paranoid/accusatory

22
Q

Why do delusions happen?

A

Misidentification or misinterpretation

23
Q

What is Fregoli syndrome?

A

a rare disorder in which a person holds a delusional belief that different people are in fact a single person who changes appearance or is in disguise

24
Q

What are the non-pharmacologic interventions for delusions?

A 
Reassurance
Distraction
Benign neglect
Validation therapy
Remove objects that are being misidentified
25
Q

What are the pharmacologic interventions for delusion?

A

Atypical antipsychotics

26
Q

How do you manage hallucinations without drugs?

A

Reassurance
Distraction
Benign neglect

27
Q

When are drugs recommended for hallucinations? What are the drugs of choice?

A

disturbing enough–use atypical antipsychs

28
Q

What are the non-pharmacologic interventions for resistiveness to care?

A

gentle, slow approach and avoid distractions

29
Q

What is the drugs utilized for resistiveness to care?

A

Benzos

30
Q

Disinhibition is most often seen with what type of dementia?

A

Frontotemporal lobe

31
Q

What are the non-drug interventions for disinhibition?

A

Avoid situations
Examine environment

Carry information card

32
Q

What are the drugs used for disinhibition?

A

Anticonvulsants
SSRIs
Beta blockers

33
Q

What are the drugs for sexual disinhibition?

A

SSRIs
Medroxyprogesterone acetate
Lupron

34
Q

Lupron is not given full dose right away due to what?

A

Surge in activity of FSH/LH, causing flare of symptoms (later it will go down)

35
Q

True or false: there is no great pharmacologic treatment for wandering

A

true

36
Q

What are the interventions for wandering?

A

Provide daytime exercise
lock doors
Placing tape across the door

37
Q

Do apathy and depression go hand in hand?

A

Not always

38
Q

What are the treatment options for apathy?

A

Provigil and ritalin

39
Q

What fraction of pts wtih dementia have depression?

A

25%

40
Q

What are the treatments of depression?

A

SSRIs

getting exercise and sleep

41
Q

Why should depression be suspected in dementia patients?

A

Cannot communicate feelings well

42
Q

What happens to the sleep cycle as dementia progresses?

A

Worsens

43
Q

What are the non-pharmacologic treatments of sleep disturbance?

A

Good sleep hygiene
Exercise
Restrict EtOH and caffeine

44
Q

True or false: you should avoid benzos for sleep problems

A

True, except for restoril

45
Q

What are the meds used to treat sleep problems?

A 
Sonata
Ambien
Low dose atypical antipsychs
Trazadone
melatonin
46
Q

What is the DELIRIUM mnemonic?

A 
Drugs
Electrolytes
Lack of drugs
Infx
Reduced sensorium
Intracranial
UTI
Myocardial/pulmonary
47
Q

What are the four A’s of Alzheimer’s?

A

Agnosia
Apraxia
Amnesia
Aphasia

Geriatrics (30 decks)

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