Geriatric Psychopharmacology

Depression

100

common feature of major depressive episode unique to geriatric population

memory concerns

200

First-line treatment for MDD in geriatric patient

SSRI, plus therapy

300

True of false: ECT should not be used to treat refractory depression in the elderly due to its cognitive side effects

false

400

This antidepressant is generally safe and effective in older adults, especially those who have insomnia and appetite suppression

mirtazapine

500

Due to negative CV effects, in general do NOT use this antidepressant class in older adults

TCA's

Anxiety

100

first line treatment for anxiety disorders and panic disorder in the elderly

SSRI plus therapy

200

Depression is often comorbid with anxiety in older adults

true

300

List two negative side effects of benzodiazepine use in older adults

cognitive impairment (memory loss)

delirium

psychomotor problems including poor coordination and falls

tolerance

dependence

400

For panic attacks, short acting hydroxyzine (brand name Atarax) is a good alternative to Benzodiazepines

false - hydroxyzine is anticholinergic

500

true or false: in general, GAD is less prevalent in older adults than in younger adults

true

Dementia

100

most common cause of dementia

Alzheimer's 

200

true or false: SSRI's are contraindicated in patients with dementia

false

300

There is an FDA black box warning for this class of drugs in geriatric patients with dementia

all antipsychotics

400

Name two side effects of donezepil (brand name Aricept)

bradycardia

syncope

cholinergic sxs, GI distress 

possible hepatotoxicity if liver disease

500

If a patient with cognitive impairment is unable to remember 5 words (delayed recall) but then is able to remember some of them after being given clues, what is the most likely cause of the dementia?

vascular

Delirium

100

first line treatment for delirium

verbal redirection, consistency of environment, establishment of day/night cycles, and frequent re-orientation

200

this common, often over-the-counter medication class used for sleep aid and allergies is a cause of delirium in older adults

anticholinergics

300

this sedative/hypnotic anxiolytic medication class can cause delirium in older adults. withdrawal from this medication can also cause delirium and seizures

benzodiazepines

400

in all adults, withdrawal from this substance is one of the most frequent and most dangerous causes of delirium (and seizures)

alcohol

500

percentage of hospitalized older adults with delirium

20%