Flashcards in 10 Deck (14)
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1
buspirone MOA
MOA: 5HT1A agonist
Good for GAD but takes 4-6 week for effect
2
mirtazepine MOAs
*Alpha2 blockade and NaSSA
5HT1A agonist: antidepressant/anxiolytic benefit
5HT2A antagonist: sleep
5HT2C antagonist: wt gain
H1 antag: sedation, wt gain, anxiolytic
Less antihistamine and more NE effect at higher doses
3
trazodone MOA
Inhibits presynaptic 5HT reuptake and blocks postsynaptic 5HT2
4
valproate Rx
Acute Mania, mixed mania (Better with Rapid cycling and dysphoric mania)
epilepsy
migraine prophalyxis
5
carbamazepine Rx
Acute mania, maintenance, rapid cycling, mixed episodes
6
creutzfeld-jacob
Rapidly progressive dementia
Often with movement disorder (Parkinsonism, cerebellar signs)
7
non-pharm treatments of delirium
• Orientation techniques
• Familiarizing patient with environment
• Natural lighting and diurnal cues
• Avoid restraints
• Caregiver support and education
• Reduce/discontinue unnecessary medications, opiates, anticholinergics, benzos
8
pharm treatments of delirum
-antipsychotics- *haldol, atypicals (TBI)
-benzos (etoh withdrawal)
-anticonvulsants (ictal)
9
delirium symptoms
• Background slowing on EEG
• Sleep-wake disturbance
• psych: hallucinations, delusions, affect lability, anxiety
• Movement alterations: hyperactive or hypo or mixed
• cognitive: attention, memory deficits, disoriented
FLUCTUATES, ACUTE
10
Confusion Assessment Method (CAM)
1. History of acute onset of change in patient’s normal mental status & fluctuating course?
AND
2.Lack of attention? AND EITHER
3. Disorganized thinking?
4. Altered Level of Consciousness
11
delirium differential
VITAMINS
Vascular
Infectious
Toxic (OD, withdrawal)
Trauma (concussion)
Autoimmune
Metabolic (electrolytes, liver)
Iatrogenic
Neoplasms
Seizures
12
iatrogenic causes of delirum
Restraints
Urinary catheters
Multiple procedures
Sleep deprivation
Untreated pain
Variety of medications(refer to handout) Surgery
13
Best established neurotransmitter dysfunction in delirium
reduced cholinergic activity
14
