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Dementia Pt. Mgt.

Treatment and Management of Dementia Patients

**ADRD = Alzheimer Dementias/Related Dementias**
ADRD care ? * usu family/med staff at homes.... be empathetic to givers, bc there is a lot of turnover bc of burnout from stress from taking care of pts.... get care giver burden- can have neg outcomes for giver and pt
For caregivers , what do we screen ? * Caregivers Burden Inventory... CBI... *ask about their depression and if they have thoughts of harming themselves/ADRD pt
Some developmental issues with ADRD pts and caregivers ? * suffering social life, emotionally drained, retired and now have to fully assist spouse
Physical Sx ? * no sleep, bad health, emotionally drained
Social Sx ? * resentful of relatives who don't help out, stop hanging out w/ friends, family relationships suffer
What to do to help w/ Caregiver Stress ? * praise their efforts and just communicate with them
Top thing to do when managing ADRD pts ? * Educate them
Meds for Alzheimers ? * Cholinesterase inhibitors ---Aricept (donepezil) -Aricept ER -Exelon (rivastigmine): pills or patches -Razadyne (galantamine) ..........**NMDA inhibitors--- -Namenda (memantine) -Namenda ER
Why is Aricept (generic for Donepezil) popular ? * bc only dosed once a day
Dosing Considerations ? * CrCl in every drug except Donepezil
Alternative non Pharmacologic ? * Vit E - shown to preserve ADLs, no to stop dementia decline...... *Axona (medical food) - keeps pt in a ketotic state
Mgt of medical issue w/ ADRD * can have low compliance, but need managed.... * Watch for ADRD drugs to exacerbate other medical issues (150/90 bp is ok)
What to do if caretaker said the ADRD pt is acting weird all of a sudden/ out of the norm ? * get a UA - bc issues are harder to find in demented pts bc they can't remember whats going on
Geriatric Dementia and Depression ? * screen for both, bc they can overlap and lead in to one another
If ADRD with Depression tmt ? * SSRIs, lose dose and bump up..... NO TCAs...* trazadone or mirtazipine if sleep issues
Disturbance of consciousness with reduced ability to focus, sustain, or shift attention and Disturbance develops over a short period of time (usually hours to days) and tends to fluctuate during the course of the day ? * Delirium
Delirium Consequences ? * falls/fractures/illnesses, etc... Anesthesia can send a geriatric pt into a delirious state
Causes of Delirium ? *D - drugs, E - electrolytes, L - lack of drugs/withdrawal, I - infct, R - reduced sensory input, I - intercranial issues (bd/stroke), U - urinary infct/retention/fecal impaction, M - MI issues
Delirium mgt ? * non-pharm 1st !.... * quetiapine is DOC
Treatment of Lewy Body ? * Avoid antipsychotics and AVOID Razadyne (galantimine) - cause death !!! ---- * use approved ACh esterase inhibitor drugs or add memantine
Behavioral and Psychological Symptoms of Dementia (BPSD) ? * wandering, anger, avoid changing house stuff bc causes confusion, psychosis issues, depression, sleep issues,
BPSD mgt ? * educate caregivers/pt, safe environments, avoid tasks they can not do, ask ?s bc pt can't remember drug adverse RXns etc.... *
BPSD drugs ? *antipsychotics if psychosis, SSRIs if depressed, Anxious/Angry think Benzos, for apathy use stimulants
Sudden onset of Laughing or Crying ? * Pseudobulbar Affect (PBA)----Occur out of proportion or incongruent to the underlying emotional state....... *FDA Tmt drug = Nuedextra
Medication Safety and ADRD ? * only add meds if you have to and watch for adverse effects since pt can't remember them
Transitions of Care and ADRD ? * getting the person with ADRD back home is the very best thing you can do.... * make care comfortable bc Alz is a terminal disease
Feeding tubes in end of life care ? * NOT shown at all to help...do not use
EOLC of Symptoms ? * More sensitive to narcotics – reg time control dose is best, but often respond to RTC acetaminophen -----* Narcotics if necessary, but use RTC regimens, remembering that patients will not be able to ask
Possible preventive measures of ADRD ? * healthy lifestyle, Mediterranean Diet - high olive oils, keep mind active, Avoid Modern Anti persperants “ Aluminum Chlorhydrate” – can cause dementias
Created by: thamrick800