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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

MMSE interpretation of score

A score of less than 24 points is suggestive of dementia or delirium