Psych and pharmacology Flashcards
True or false: most patients with dementia will have some major psych/behavioral difficulty
True
Which usually causes more suffering for pts and families: the cognitive decline associated with dementia, or the psych problems that come with it?
The psych problems
When a pt with dementia develops new symptomatology, why must this be evaluated carefully?
Pts have problems communicating what they are experiencing
What is the first step to evaluating a psych problem?
H&P
Why is the PE important in a psych exam?
often with these patients their only expression of a physical ailment may be a change in mental status
True or false: the dementias mneonic is useful for evaluating psych diagnoses
True
All psych diagnoses demand consideration of what?
for the intervention regarding the triggering events, environment, caregiver stress,
What is agitation?
non-specific umbrella term for many behavoirs and symptoms
Why is it important to get the most specific description of agitation?
To get effective treatment
What are the non-pharmacological treatments for agitation? (4)
Routine
Remove environmental triggers
Quiet environment
Address pain
What are the pharmacologic interventions for agitation? (6)
- Buspar
- SSRIs
- Anticonvulsants
- Benzos
- Antipsychs
- Cholinesterase inhibitors
What are benzos?
Anticonvulsants
Antipsychotic
Anxiolytics
What are the problems with Benzos?
Increase falling and are sedative
What is the MOA of old antipsychotics?
Block D2 receptors (dopamine)
What are the dangers of antipsychotics?
Sudden death
What is sundowning?
Agitation in which the pt has symptoms in ithe afternoon or late evening
What are the treatments for sundowning?
Routine
Remove environmental triggers
Quiet environment
Address pain
When should medication be given for sundowners?
30-60 minutes prior to onset of symptoms
How can lighting be used to minimize the effect of sundowning?
Gradual decrease in light
What are the meds that can be used for sundowning?
Trazadone
Benzos
Antipsychotics
What are delusions?
False beliefs that are usually paranoid/accusatory
Why do delusions happen?
Misidentification or misinterpretation
What is Fregoli syndrome?
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
What are the non-pharmacologic interventions for delusions?
Reassurance Distraction Benign neglect Validation therapy Remove objects that are being misidentified
What are the pharmacologic interventions for delusion?
Atypical antipsychotics
How do you manage hallucinations without drugs?
Reassurance
Distraction
Benign neglect
When are drugs recommended for hallucinations? What are the drugs of choice?
disturbing enough–use atypical antipsychs
What are the non-pharmacologic interventions for resistiveness to care?
gentle, slow approach and avoid distractions
What is the drugs utilized for resistiveness to care?
Benzos
Disinhibition is most often seen with what type of dementia?
Frontotemporal lobe
What are the non-drug interventions for disinhibition?
Avoid situations
Examine environment
Carry information card
What are the drugs used for disinhibition?
Anticonvulsants
SSRIs
Beta blockers
What are the drugs for sexual disinhibition?
SSRIs
Medroxyprogesterone acetate
Lupron
Lupron is not given full dose right away due to what?
Surge in activity of FSH/LH, causing flare of symptoms (later it will go down)
True or false: there is no great pharmacologic treatment for wandering
true
What are the interventions for wandering?
Provide daytime exercise
lock doors
Placing tape across the door
Do apathy and depression go hand in hand?
Not always
What are the treatment options for apathy?
Provigil and ritalin
What fraction of pts wtih dementia have depression?
25%
What are the treatments of depression?
SSRIs
getting exercise and sleep
Why should depression be suspected in dementia patients?
Cannot communicate feelings well
What happens to the sleep cycle as dementia progresses?
Worsens
What are the non-pharmacologic treatments of sleep disturbance?
Good sleep hygiene
Exercise
Restrict EtOH and caffeine
True or false: you should avoid benzos for sleep problems
True, except for restoril
What are the meds used to treat sleep problems?
Sonata Ambien Low dose atypical antipsychs Trazadone melatonin
What is the DELIRIUM mnemonic?
Drugs Electrolytes Lack of drugs Infx Reduced sensorium Intracranial UTI Myocardial/pulmonary
What are the four A’s of Alzheimer’s?
Agnosia
Apraxia
Amnesia
Aphasia
