10 Flashcards
(14 cards)
buspirone MOA
MOA: 5HT1A agonist
Good for GAD but takes 4-6 week for effect
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
trazodone MOA
Inhibits presynaptic 5HT reuptake and blocks postsynaptic 5HT2
valproate Rx
Acute Mania, mixed mania (Better with Rapid cycling and dysphoric mania)
epilepsy
migraine prophalyxis
carbamazepine Rx
Acute mania, maintenance, rapid cycling, mixed episodes
creutzfeld-jacob
Rapidly progressive dementia
Often with movement disorder (Parkinsonism, cerebellar signs)
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
pharm treatments of delirum
- antipsychotics- *haldol, atypicals (TBI)
- benzos (etoh withdrawal)
- anticonvulsants (ictal)
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
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
delirium differential
VITAMINS
Vascular Infectious Toxic (OD, withdrawal) Trauma (concussion) Autoimmune Metabolic (electrolytes, liver) Iatrogenic Neoplasms Seizures
iatrogenic causes of delirum
Restraints Urinary catheters Multiple procedures Sleep deprivation Untreated pain Variety of medications(refer to handout) Surgery
Best established neurotransmitter dysfunction in delirium
reduced cholinergic activity
MMSE interpretation of score
A score of less than 24 points is suggestive of dementia or delirium