Geriatric Pharmacology & Pain Management

<p>Optimize pain control and consider SSRIs. (D)</p> Signup and view all the answers

<p>Quetiapine (A)</p> Signup and view all the answers

<p>Cerebrovascular disease and infections (D)</p> Signup and view all the answers

<p>0.25 mg twice daily (C)</p> Signup and view all the answers

<p>Every 2 weeks (D)</p> Signup and view all the answers

<p>Prioritize one-on-one observation and consider antipsychotic medications after discussing risks and benefits with surrogates or guardians. (B)</p> Signup and view all the answers

<p>Assessing and treating any underlying causes of discomfort, such as pain or constipation. (D)</p> Signup and view all the answers

<p>Because they rarely have adverse effects, unlike medications, and may benefit individual patients. (C)</p> Signup and view all the answers

<p>Training the caregiver in the 'Bathing without a Battle' protocol. (C)</p> Signup and view all the answers

<p>Understanding behavioral disturbances as responses to discomfort and learning de-escalation techniques. (B)</p> Signup and view all the answers

<p>Nursing Assistant (D)</p> Signup and view all the answers

<p>Music therapy. (C)</p> Signup and view all the answers

<p>Developing behavioral plans that incorporate non-pharmacological strategies. (A)</p> Signup and view all the answers

<p>Engaging the patient in reminiscence therapy or listening to calming music. (A)</p> Signup and view all the answers

<p>Creating a soothing enviroment with optimal levels of stimulation (C)</p> Signup and view all the answers

<p>By identifying potential medication interactions and verifying dosing regimens. (A)</p> Signup and view all the answers

<p>To record caregiver ratings of symptoms, medications, schedules and instructions from various disciplines. (A)</p> Signup and view all the answers

<p>Recommending modifications to the home environment to reduce hazards. (D)</p> Signup and view all the answers

<p>It can lead to over-diagnosis and unnecessary antibiotic use, contributing to antibiotic resistance. (C)</p> Signup and view all the answers

<p>Fever, dysuria, suprapubic pain, or new/increased urinary frequency, urgency, or incontinence. (A)</p> Signup and view all the answers

<p>Ensuring the safety of the patient and others. (A)</p> Signup and view all the answers

<p>Delirium indicates an underlying medical condition requiring prompt evaluation and treatment. (D)</p> Signup and view all the answers

<p>Caregivers' interpretations of generic terms may vary, potentially leading to miscommunication. (A)</p> Signup and view all the answers

<p>Onset, frequency, timing, trajectory of symptoms, and relationship to environmental or medication changes. (A)</p> Signup and view all the answers

<p>Patients with dementia are more susceptible to CNS effects, and not all problematic medications are easily recognized. (C)</p> Signup and view all the answers

<p>Aggressive behaviors endangering themselves or others, or refusal of basic care. (C)</p> Signup and view all the answers

<p>They exhibit fewer drug-drug interactions due to less inhibition of cytochrome p450 enzymes. (A)</p> Signup and view all the answers

<p>Methylphenidate may improve apathy, cognition, and function, while studies of cholinesterase inhibitors, Memantine, and antidepressants have not demonstrated a benefit for apathy. (C)</p> Signup and view all the answers

<p>Begin with the immediate-release formulation at 2.5 mg or 5 mg twice daily (morning and early afternoon) and titrate up by 2.5 mg or 5 mg weekly. (B)</p> Signup and view all the answers

<p>4 weeks (D)</p> Signup and view all the answers

<p>To avoid prematurely abandoning an effective strategy, as change is often gradual and may not be noticeable until comparing behavior diaries over several weeks. (A)</p> Signup and view all the answers

<p>Patients with agitation at baseline. (D)</p> Signup and view all the answers

<p>An established, clear baseline regarding the frequency and severity of target behaviors. (D)</p> Signup and view all the answers

<p>A combination of Citalopram and Methylphenidate led to a greater response rate than either medication alone, without an increase in adverse effects. (D)</p> Signup and view all the answers

<p>To monitor for adverse motor effects and minimize the risk of long-term side effects, as well as the black box warning of increased risk of death in geriatric patients. (A)</p> Signup and view all the answers

<p>Clozapine (B)</p> Signup and view all the answers

<p>Begin with a low dose, increase slowly, and adjust according to the patient's response and tolerance. Citalopram should be started at 10 mg daily and Sertraline at 25 mg daily. (A)</p> Signup and view all the answers

<p>The increased risk of death associated with antipsychotic use in geriatric patients with dementia. Antidepressant dosing strategies used in the studies were the same as for depression. (C)</p> Signup and view all the answers

<p>Antipsychotic discontinuation can be successful in many patients without worsening BPSD, as evidenced by a longitudinal study. Discontinuation may be less successful for patients who have had severe symptoms. (B)</p> Signup and view all the answers

<p>Starting and target dose is the same (34 mg). (A)</p> Signup and view all the answers

<p>No difference in agitation scores was seen, and patients had an average increase in corrected QT interval of 18 ms. (C)</p> Signup and view all the answers

<p>Pimavanserin (C)</p> Signup and view all the answers

Bacteriuria occurs in up to 50% of institutionalized patients.

Revised criteria for diagnosing UTIs focus on specific symptoms rather than cultures alone.

Fever, dysuria, suprapubic pain, increased urinary frequency, urgency, or incontinence are key signs.

Delirium is a rapid change in mental status due to medical conditions or substances.

Patients with aggressive behavior or severe symptoms may need more urgent care, like hospitalization.

Caregivers should describe specific behaviors instead of vague terms like 'depression'.

Assess medication changes as they can affect patient behaviors, especially in dementia.

Symptom changes may relate to new environments or situations, like moving to a facility.

Management involves assessing discomfort and implementing non-pharmacological interventions.

Maximum recommended dose is 3 g/day for pain management.

Consultation regarding the pros and cons of using antipsychotic medications for dangerous patients.

Transdermal lidocaine, diclofenac gel, and methyl salicylate cream are safe for localized pain.

Techniques used to manage BPSD without medication, aimed at reducing symptoms.

Duloxetine, Gabapentin, and Pregabalin can treat neuropathic pain but may increase fall risk.

Tramadol has a higher risk of falls compared to other opioids in the elderly.

Education for caregivers on managing BPSD through understanding and de-escalation techniques.

A protocol aimed at easing agitation during personal care like bathing.

Second-generation antipsychotics treat agitation, but have small effect sizes and possible severe side effects.

Antipsychotics carry a black box warning for the elderly with dementia due to increased death risk.

A non-drug intervention shown to reduce overall behavioral symptoms in patients with dementia.

A technique that may help reduce depression symptoms in dementia patients.

Starting doses: Aripiprazole 2 mg, Olanzapine 2.5 mg, Quetiapine 12.5 mg, Risperidone 0.25 mg for BPSD.

Using scents to potentially enhance well-being and reduce agitation in dementia patients.

Increase antipsychotic doses in small increments every 2 weeks if necessary for treatment effectiveness.

Clinicians should avoid antipsychotics except Quetiapine, Pimavanserin, and Clozapine due to worsening motor symptoms.

Pimavanserin is FDA-approved for Parkinson's disease psychosis but has a black box warning.

Clozapine requires special monitoring and reporting when prescribed.

Discontinuing antipsychotics often succeeds without worsening BPSD in most patients.

SSRIs like Citalopram and Sertraline showed improvement in agitation symptoms associated with BPSD.

Citalopram began at 10 mg daily, shown to improve BPSD; similar efficacy to placebo in trials.

The mantra for treating BPSD with SSRIs emphasizes cautious titration to avoid worsening symptoms.

Both antipsychotics and certain SSRIs can prolong the QT interval, raising health risks.

A coordinated team approach involving multiple healthcare disciplines to manage patient care effectively.

Nurses are key in identifying, quantifying, and monitoring behavioral and psychological symptoms of dementia (BPSD).

Social workers connect family caregivers with resources like education, respite, and permanent placement options.

Clear communication among team members is crucial for effective management of BPSD and patient safety.

SSRIs like Citalopram are more effective than other antidepressants for responders and remitters, though evidence quality is lower.

Combining Citalopram and Methylphenidate improves response rates in non-demented elderly without increased adverse effects.

Elderly patients showed benefits from Citalopram doses above 20 mg daily, but benefits below this dose are unclear.

Citalopram and Sertraline have fewer drug-drug interactions compared to Paroxetine or Fluoxetine, which affect cytochrome p450 enzymes.

Methylphenidate can improve apathy and cognition with minimal side effects, though some patients may experience hallucinations.

In the ADMET trial, Methylphenidate had no significant cardiac impact but resulted in some weight loss among patients.

A systematic pharmacotherapy approach for BPSD includes establishing a clear baseline and allowing an adequate trial period for medications.

Educating caregivers is vital, as behavior changes can be gradual and may require long-term observation to notice.