first line medication for delirium/acute confusional state
haloperidol
shorter half life than Benzos
avoid in Parkinsons patients: use lorazepam instead
2nd line treatment for Alzheimers dementia
Memantine
glutamate receptor antagonist
what is an advanced decision?
legally binding?
An Advanced Decision, short for Advanced Decision to Refuse Treatment, is a legally binding document. Its purpose is to ensure that an individual can refuse a specific treatment(s) that they do not want to have in the future.
what is an advanced statement?
legally binding?
An Advance Statement is sometimes called a “Statement of Wishes and Care Preferences”. It allows an individual to make general statements about their wishes, beliefs, feelings and values and how these influence their preferences for their future care and treatment
An Advanced Statement can be made verbally and not by itself legally binding, but legally must be taken into consideration when making a “best interests” decision on someone’s behalf under the Mental Capacity Act
what can an advanced decision not do?
refuse basic care like nutrition, daily care like washing and comfort treatment like painkillers
Also can’t request treatment
medication to treat restlessness and agitation in end-of-life patients.
midazolam in syringe driver
numerical definition of postural hypotension
> 20mmHg in systolic blood pressure or >10mmHg in diastolic blood pressure within 3 minutes of standing
sign of autonomic dysfunction
MoA of donepezil
increase ACh in the brain
condition characterised by hallucinations secondary to visual impairment
Charles Bonnet Syndrome
imaging findings most likely to be associated with vascular dementia
white matter hyper intensities on MRI
CAM diagnostic criteria for delirium [4]
1) acute onset with fluctuating course
2) inattention
3) disorganised thinking
4) altered level of consciousness.
drugs that lower seizure threshold
Drugs
Asthma:
Pysch: Antipsychotics, Bupropion, Venlafaxine
Antibiotics: Imipenem, penicillins, cephalosporins, metronidazole, isoniazid
NSAIDs: mefanmic acid
Opiates: Tramadol
Fentanyl
Ketamine
Lidocaine
Lithium
Antihistamines
features of Lewy Body Dementia
presence of dementia alongside two of the three core features:
- fluctuating attention and concentration
- recurrent well-formed visual hallucinations
- spontaneous Parkinsonism
drug that may be used to treat postural hypotension [2]
midodrine (alpha 1 agonist)
fludrocortisone (SE of mineralocorticoids is hypertension)
MoA of carbidopa
peripheral decarboxylase inhibitor
central side effects of L-Dopa
Central side effects include:
Hallucinations
Confusion
Dyskinesia
Psychosis
peripheral side effect of L-Dopa [2]
Postural hypotension
Nausea & vomiting
NV treated with domperidone
Causes of orthostatic hypotension [6]
- Medications, particularly vasodilators, diuretics, negative inotropes, antidepressants, and opiates
- Chronic hypertension due to the loss of baroreceptor reflexes
- Dehydration
- Sepsis
- Autonomic nervous system dysfunction, such as Parkinson’s disease
- Adrenal insufficiency
what medication should be avoided in Lewy body Dementia
Neuroleptics
__________ are associated with a significant increase in mortality in dementia patients
Antipsychotics are associated with a significant increase in mortality in dementia patients
Grade 1 Waterlow
Non-blanchable erythema of intact skin. Discolouration of the skin, warmth, oedema, induration or hardness may also be used as indicators, particularly on individuals with darker skin
Grade 2 Waterlow
Partial thickness skin loss involving epidermis or dermis, or both. The
ulcer is superficial and presents clinically as an abrasion or blister
Grade 3 Waterlow
Full thickness skin loss involving damage to or necrosis of subcutaneous tissue that may extend down to, but not through, underlying fascia.
Grade 4 Waterlow
Extensive destruction, tissue necrosis, or damage to muscle, bone or
supporting structures with or without full thickness skin loss
