Psych and pharmacology Flashcards Preview

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Flashcards in Psych and pharmacology Deck (47):
1

True or false: most patients with dementia will have some major psych/behavioral difficulty

True

2

Which usually causes more suffering for pts and families: the cognitive decline associated with dementia, or the psych problems that come with it?

The psych problems

3

When a pt with dementia develops new symptomatology, why must this be evaluated carefully?

Pts have problems communicating what they are experiencing

4

What is the first step to evaluating a psych problem?

H&P

5

Why is the PE important in a psych exam?

often with these patients their only expression of a physical ailment may be a change in mental status

6

True or false: the dementias mneonic is useful for evaluating psych diagnoses

True

7

All psych diagnoses demand consideration of what?

for the intervention regarding the triggering events, environment, caregiver stress,

8

What is agitation?

non-specific umbrella term for many behavoirs and symptoms

9

Why is it important to get the most specific description of agitation?

To get effective treatment

10

What are the non-pharmacological treatments for agitation? (4)

Routine
Remove environmental triggers
Quiet environment
Address pain

11

What are the pharmacologic interventions for agitation? (6)

1. Buspar
2. SSRIs
3. Anticonvulsants
4. Benzos
5. Antipsychs
6. Cholinesterase inhibitors

12

What are benzos?

Anticonvulsants
Antipsychotic
Anxiolytics

13

What are the problems with Benzos?

Increase falling and are sedative

14

What is the MOA of old antipsychotics?

Block D2 receptors (dopamine)

15

What are the dangers of antipsychotics?

Sudden death

16

What is sundowning?

Agitation in which the pt has symptoms in ithe afternoon or late evening

17

What are the treatments for sundowning?

Routine
Remove environmental triggers
Quiet environment
Address pain

18

When should medication be given for sundowners?

30-60 minutes prior to onset of symptoms

19

How can lighting be used to minimize the effect of sundowning?

Gradual decrease in light

20

What are the meds that can be used for sundowning?

Trazadone
Benzos
Antipsychotics

21

What are delusions?

False beliefs that are usually paranoid/accusatory

22

Why do delusions happen?

Misidentification or misinterpretation

23

What is Fregoli syndrome?

a rare disorder in which a person holds a delusional belief that different people are in fact a single person who changes appearance or is in disguise

24

What are the non-pharmacologic interventions for delusions?

Reassurance
Distraction
Benign neglect
Validation therapy
Remove objects that are being misidentified

25

What are the pharmacologic interventions for delusion?

Atypical antipsychotics

26

How do you manage hallucinations without drugs?

Reassurance
Distraction
Benign neglect

27

When are drugs recommended for hallucinations? What are the drugs of choice?

disturbing enough--use atypical antipsychs

28

What are the non-pharmacologic interventions for resistiveness to care?

gentle, slow approach and avoid distractions

29

What is the drugs utilized for resistiveness to care?

Benzos

30

Disinhibition is most often seen with what type of dementia?

Frontotemporal lobe

31

What are the non-drug interventions for disinhibition?

Avoid situations
Examine environment

Carry information card

32

What are the drugs used for disinhibition?

Anticonvulsants
SSRIs
Beta blockers

33

What are the drugs for sexual disinhibition?

SSRIs
Medroxyprogesterone acetate
Lupron

34

Lupron is not given full dose right away due to what?

Surge in activity of FSH/LH, causing flare of symptoms (later it will go down)

35

True or false: there is no great pharmacologic treatment for wandering

true

36

What are the interventions for wandering?

Provide daytime exercise
lock doors
Placing tape across the door

37

Do apathy and depression go hand in hand?

Not always

38

What are the treatment options for apathy?

Provigil and ritalin

39

What fraction of pts wtih dementia have depression?

25%

40

What are the treatments of depression?

SSRIs
getting exercise and sleep

41

Why should depression be suspected in dementia patients?

Cannot communicate feelings well

42

What happens to the sleep cycle as dementia progresses?

Worsens

43

What are the non-pharmacologic treatments of sleep disturbance?

Good sleep hygiene
Exercise
Restrict EtOH and caffeine

44

True or false: you should avoid benzos for sleep problems

True, except for restoril

45

What are the meds used to treat sleep problems?

Sonata
Ambien
Low dose atypical antipsychs
Trazadone
melatonin

46

What is the DELIRIUM mnemonic?

Drugs
Electrolytes
Lack of drugs
Infx
Reduced sensorium
Intracranial
UTI
Myocardial/pulmonary

47

What are the four A's of Alzheimer's?

Agnosia
Apraxia
Amnesia
Aphasia