SUD Emergencies Flashcards
What is the first line agent used in the agitated patient ?
second generation antipsychotics
What is the BBW for haloperidol?
risk of use for dementia related psychosis.
lengthens QT interval
motor related side effects
DONT USE AS SINGLE AGENT
Ketamine is proposed as treatment for both, patients with ________________, which is when a patient is at high risk of death if not emergently treated and for patients who have proven _________________.
excited delirium
refractory to other antipsychotics
What two medications do you want to avoid in the elderly population?
benzo’s and antihistamines- prolonged sedation/agitation.
What is the most prevalent substance use problem in adults?
alcohol abuse.
What is the preferred pharm for elderly?
risperidone, olanzapine, quetiapine, haloperidol
Patients with dementia are more likely to develop delirium and patients who experience delirium are more likely to develop dementia later on in life.
What is delirium? What are the 3 main types?
- acute change in cognition that fluctautes RAPIDLY over time and is REVERSIBLE
- Delirium is frequently the first sign of an underlying acute medical illness
- Patients demonstrate altered level of consciousness, inattention, disorganized thinking, altered perception.
3 types:
1. hyperactive
2. hypoactive
3. mixed
Delirium is a common disorder in the ______________.
elderly
What are the environmental risk factors for delirium ?
- functional dependence
- living in a nursing home
- hearing impairment
The ED is an independent predictor of ___________ mortality when it comes to delirium.
6 month
You ALWAYS want to check this lab- ______________ in patients with delirium. Infection often manifests as _______________ in elderly, most common being ______________, also COVID-19
glucose
AMS
UTI
In a patient with delirium, you want to avoid precipitating factors iatrogenic delerium in the hospital:
1.
2.
3.
4.
- physical restraints
- malnutrition
- use of a bladder catheter
- more than 3 meds added at a time
Dementia is defined as significant decline in cognitive function in one or more of the following cognitive domains:
- learning and memory
- language
- executive function
- complex attention
- perceptual motor
- social cognition
_________________ is the most common type of dementia.
alzheimer’s
What is sundowning
it is when patients with dementia experience behavioral disturbances
Patients with lewy body dementia do poorly when given ______________ so AVOID THEM in these patients.
typical antipsychotics.
The DSM 5 requires ____________ of the 11 criteria for diagnosis of substance and alcohol use disorder and determines severity. Also terminology is “alcohol use disorders” mild, moderate or severe.
2 or more
Binge drinking is blood etoh level over the US legal limit of _______________
average male =
average female=
0.08 g/dL
4 drinks in 2 hours
3 drinks in 2 hours
Acute alcohol intoxication is BAL of ______________
> 0.080 g/DL
Alcohol related disorders:
Syndrome and their clinical findings
1. Minor withdrawl
2. seizures
3. alcoholic hallucinations
4. delirium tremens
- mild anxiety, HA, diaphoresis, palpitations, anorexia, GI upset, normal mental status
- generalized tonic-clonic, short post ictal period
- visual, auditory, and or tactile hallucinations with intact orientation and normal VS
- delirium, agitation, tachy, HTN, fever, diaphoresis
If alcohol withdrawal does not progress, symptoms generally resolve within 24-48 hrs. If 24 hours pass since the last drink without development of symptoms in someone not at risk for major withdrawal… what is the treatment?
no medications are indicated since symptoms are unlikely to develop
Clinical institute withdrawal assessment for alcohol. (CIWA-Ar)
0-9 points=
10-15 points=
16-20=
21-67 =
very mild withdrawal
mild withdrawal
modest withdrawal
severe withdrawal
What is the ambulatory manangement for mild symptoms of alcohol withdrawal (CIWA-Ar) less than 15 or asymptomatic pts with a hx of symptoms with past attempts to reduce their drinking.
- longer acting benzo’s such as chlordiazepoxide or diazepam
- short acting for hepatic impairment - lorazepam
What is the criteria for an inpatient alcohol withdrawal detox?
fever disorientation drenching sweats
severe tachy
hypotension
pregnancy
concurrent substance use that lead to withdrawl sx e.g. benzos
abnormal labs