Acute agitation Flashcards
solidify information? (36 cards)
What is critical to obtain from all patients, especially vulnerable ones?
Consent
Consent must be obtained from a substitute decision maker if agitated patients lack the capacity to consent.
What are the associated risks of long-term use of antipsychotics in elderly patients with dementia?
Increased risks of strokes and deaths
Antipsychotics should be used when risks outweigh benefits, for the shortest duration at the lowest effective dose.
When should antipsychotics be used for elderly patients with agitation?
On an individual basis with caregiver consent
This applies particularly when treating confusional states.
What is the first-line treatment for delirium if non-pharmacological options fail?
Antipsychotics
Used when the risks of harm exceed the risks of antipsychotic use.
Which medication is most studied for decreasing agitation in delirious patients?
Haloperidol
It is not approved by Health Canada for this indication.
What dosing method is preferred for Haloperidol?
Regular scheduled dosing
This is preferred over ‘when needed’ dosing.
List some first-generation and second-generation antipsychotics used for agitation.
- First-generation: Loxapine
- Second-generation: Olanzapine, Risperidone, Quetiapine
Haloperidol is effective but not recommended in non-emergency situations.
What did a Cochrane study reveal about low-dose Haloperidol?
Similar effects to second-generation antipsychotics in reducing delirium scores
It also showed similar decreased duration of delirium and incidence of side effects.
What is a potential issue with higher doses of Haloperidol?
Increased extrapyramidal side effects
This is a risk compared to Quetiapine and Risperidone.
What are ODTs and when are they beneficial?
Orally disintegrating tablets; beneficial for patients unable to swallow tablets
Examples include Olanzapine and Risperidone.
What should never be combined with Olanzapine IM?
Benzodiazepines IM
This combination can lead to complications.
What is the recommendation for using antipsychotics in dementia?
Only if benefits outweigh risks after non-pharmacological interventions fail
This applies to second-generation antipsychotics.
Which antipsychotic has a favorable effect on agitation in Alzheimer’s disease?
Risperidone
Higher doses lead to more efficacy but also more side effects like falls.
Why isn’t a lewy body dementia patient recommended treatment with second Generation antipsychotics?
what should be used instead?
they have enhanced sensitivity to second generation antipsychotics.
insteaed use chlinesterase inhibitors such as Donepzil
What is the effect of SSRIs on agitation and psychosis?
Modest reduction
They may help in managing symptoms.
What is Trazodone’s role in agitation management?
Unclear efficacy but may lower aggression
It has better evidence as a hypnotic and for sleep disorders.
What are the risks associated with benzodiazepines?
Falls, impaired cognition, and disinhibition
They are useful for anxiety and agitation.
Which benzodiazepines are preferred for elderly patients?
- Lorazepam
- Oxazepam
- Temazepam
They lack active metabolites and are minimally affected by aging.
What is the best acute treatment for agitation in acquired brain injury?
Beta adrenergic antagonists
This is based on limited evidence.
What should be avoided as first-line agents in brain-injured patients?
- Amantadine
- Buspirone
- Lithium
These agents are not recommended.
What should be used for acutely psychotic patients?
Short-acting parenteral formulations of antipsychotics
Haloperidol plus parenteral lorazepam is a common treatment.
What is the recommendation for benzodiazepines in treating mania?
Not to be used as monotherapy
They should be combined with mood stabilizers.
What should be prioritized in treating situational agitation?
Non-pharmacologic choices
This is essential before pharmacological interventions.
What is the first-line combination for situational agitation?
First-generation antipsychotic plus benzodiazepine
Example: Haloperidol plus Lorazepam.
