Dementia/ Neuropsychiatric Symptoms & pain

Question 1

Antipsych Dementia treatment BBW

Answer 1

• Inc risk of death
• conventional has worst outcomes than atypical.
• haloperidol has inc risk of mortality
• quetiapine has best result

Question 2

non pharm

Answer 2

cargiver support groups
music, walking , pets

Question 3

schizoprehenia [like] syndrome in dementia and treatment

Answer 3

• hallucinations, delusions (psychotic symptoms), thought disorder
• social dilapidation and apathy
• treatment: aripiprazole, olanzapine, quetiapine, risperidone, brexpiprazole

Question 4

treatment for behavioral dementia

Answer 4

-SSRIS , SNRI
- avoid paroxetine, desipramine, nortriptyline
- Mirtazapine can be used for depression with insomnia and weight loss
- Trazadone can be used when sedation is desirable

Question 5

Treatment dor dementia with manic like features

Answer 5

divalproex sodium
- sprinkle capsule
- best tolerated
also lithium, carbamazepine, lamotrigene

Question 6

dementia sun down treatment

Answer 6

• non-pharm: night lights, check in
• acute: trazadone, CHAPs, atypical antipsych (quetiapine)
• longer term: trazadone, melatonin ** also for insomnia dementia

Question 7

neuropathic pain and examples

Answer 7

damage to nerve leads to random firing (dysfunction in nervous system)
- diabetic neuropathy
- central poststroke pain
- buring tingling and hypersensitivity to touch or cold

Question 8

nociceptive pain

Answer 8

pain caused by injury to body tissues
- inflammation, fracture, joint pain from osteoarthritis
- aching, sharp, and throbbing

Question 9

chronic non-cancer pain overuse of opioids prevention

Answer 9

• multimodal approach
• target the mechanism of pain
• treat neuropathic pain w/ adj meds
• long acting opioid instead of short acting

Question 10

pain scales

Answer 10

FLACC and PainAD are both based on behavior over description of pain- good for pediatric and older pts for ex. dementia

Question 11

Non pharm pain management

Answer 11

• physical activity
• patient edu
• cognitive-behavioral therapies
• adjuncts: heat, cold, massage, liniments, acupuncture, etc., spirituality

Question 12

what type of pain dose adjuvant treat

Answer 12

neuropathetic pain

Question 13

Principles for prescribing pain meds

Answer 13

• admin routinely not PRN
• may do PRN to gage pt tolerance of med
• least invasive route of admin
• low dose titrate carefully
• reassess and adjust dose frequently to optimize pain relief while monitoring and managing ses

Question 14

pros of using apap for pain

Answer 14

• useful for mild to mod pain
• elder safe
• adjunctive
• starting point

Question 15

cons of using APAP for pain

Answer 15

very and rare AEs (hepatic failure, alcohol use, heaptic insufficiency, DI w/ warfarin)
- limit to <3g daily for safety
- failure to complete adquate trial

Question 16

pros of using NSAIDS for pain management

Answer 16

• mild- mod pain
• musculosketal (inf, cancer)
• used when other safer therapies fail

*diclofenac topical safest, use before orals
*use lowest possible effective dose in elderly

Question 17

cons of using NSAIDs for pain

Answer 17

• ceiling effect
• several absolute CIs : PUD, CKD, HF

Question 18

adjunctive pain agents

Answer 18

SNRI- Duloxetine
- lidocaine
AVOID TCAs
start low and go slow

Question 19

first line neuropathic pain treatment

Answer 19

A2 ligand - pregabalin, gabapentin
SNRI
TCA (nortiptyline) use with caution

Question 20

2nd line neuropathic pain treatment

Answer 20

topical agents like lidocaine> capsaicin
opioid for mod-severe pain (not superior to non-opioid anageslics)

Question 21

starting opioid treatment

Answer 21

• IR>ER
• start low for opioid naïve (2.5-5mg)
• optimize non-opioid therapies while continuing opioid therapy
• if risk> benefit gradually taper to lower dosages
• impending overdose symptoms- confusion, sedation, slurred speech- immediate d/c
  otherwise must taper opioids