Dementia/ Neuropsychiatric Symptoms & pain Flashcards
(21 cards)
Antipsych Dementia treatment BBW
- Inc risk of death
- conventional has worst outcomes than atypical.
- haloperidol has inc risk of mortality
- quetiapine has best result
non pharm
cargiver support groups
music, walking , pets
schizoprehenia [like] syndrome in dementia and treatment
- hallucinations, delusions (psychotic symptoms), thought disorder
- social dilapidation and apathy
- treatment: aripiprazole, olanzapine, quetiapine, risperidone, brexpiprazole
treatment for behavioral dementia
-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
Treatment dor dementia with manic like features
divalproex sodium
- sprinkle capsule
- best tolerated
also lithium, carbamazepine, lamotrigene
dementia sun down treatment
- non-pharm: night lights, check in
- acute: trazadone, CHAPs, atypical antipsych (quetiapine)
- longer term: trazadone, melatonin ** also for insomnia dementia
neuropathic pain and examples
damage to nerve leads to random firing (dysfunction in nervous system)
- diabetic neuropathy
- central poststroke pain
- buring tingling and hypersensitivity to touch or cold
nociceptive pain
pain caused by injury to body tissues
- inflammation, fracture, joint pain from osteoarthritis
- aching, sharp, and throbbing
chronic non-cancer pain overuse of opioids prevention
- multimodal approach
- target the mechanism of pain
- treat neuropathic pain w/ adj meds
- long acting opioid instead of short acting
pain scales
FLACC and PainAD are both based on behavior over description of pain- good for pediatric and older pts for ex. dementia
Non pharm pain management
- physical activity
- patient edu
- cognitive-behavioral therapies
- adjuncts: heat, cold, massage, liniments, acupuncture, etc., spirituality
what type of pain dose adjuvant treat
neuropathetic pain
Principles for prescribing pain meds
- 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
pros of using apap for pain
- useful for mild to mod pain
- elder safe
- adjunctive
- starting point
cons of using APAP for pain
very and rare AEs (hepatic failure, alcohol use, heaptic insufficiency, DI w/ warfarin)
- limit to <3g daily for safety
- failure to complete adquate trial
pros of using NSAIDS for pain management
- 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
cons of using NSAIDs for pain
- ceiling effect
- several absolute CIs : PUD, CKD, HF
adjunctive pain agents
SNRI- Duloxetine
- lidocaine
AVOID TCAs
start low and go slow
first line neuropathic pain treatment
A2 ligand - pregabalin, gabapentin
SNRI
TCA (nortiptyline) use with caution
2nd line neuropathic pain treatment
topical agents like lidocaine> capsaicin
opioid for mod-severe pain (not superior to non-opioid anageslics)
starting opioid treatment
- 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
