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Transcript
Drugs that can Cause Delirium (anticholinergic / toxic metabolites) Deliriants (drugs causing delirium) Prescription drugs Central acting agents – Sedative hypnotics (e.g., benzodiazepines) – Anticonvulsants (e.g., barbiturates) – Antiparkinsonian agents (e.g., benztropine, trihexyphenidyl) Analgesics – Narcotics (NB. meperidine*) – Non-steroidal anti-inflammatory drugs* Antihistamines (first generation, e.g., hydroxyzine) Gastrointestinal agents – Antispasmodics – H2-blockers* Antinauseants – Scopolamine – Dimenhydrinate Antibiotics – Fluoroquinolones* Psychotropic medications – Tricyclic antidepressants – Lithium* Cardiac medications – Antiarrhythmics – Digitalis* – Antihypertensives (b-blockers, methyldopa) Miscellaneous – Skeletal muscle relaxants – Steroids Over the counter medications and complementary/alternative medications Antihistamines (NB. first generation) – diphenhydramine, chlorpheniramine). Antinauseants – dimenhydrinate, scopolamine Liquid medications containing alcohol Mandrake Henbane Jimson weed Atropa belladonna extract * Requires adjustment in renal impairment. From: K Alagiakrishnan, C A Wiens. (2004). An approach to drug induced delirium in the elderly. Postgrad Med J, 80, 388–393. Delirium in the Older Person: A Medical Emergency. Island Health Drugs that can cause delirium. Reviewed: 8-2014 www.viha.ca/mhas/resources/delirium/ Some commonly used medications with moderate to high anticholinergic properties and alternative suggestions Type of medication Alternatives with less deliriogenic risk Antidepressant (e.g., TCA, tertiary) Antihistamine (e.g., diphenhydramine) Antiparkinsonian (e.g., benztropine, trihexyphenidyl) Trazodone, SSRI, TCA (secondary amine) Second generation antihistamine (e.g., loratadine) Levodopa Gastrointestinal agents, e.g., (A) Cimetidine, ranitidine (B) Dimenhydrinate Proton pump inhibitor Antispasmodic Domperidone Tolterodine (e.g., oxybutynin) Low potency antipsychotic (e.g., chlorpromazine, thioridazone) Haloperidol, atypical antipsychotic SSRI, selective serotonin reuptake inhibitor; TCA, tricyclic antidepressant. From: K Alagiakrishnan, C A Wiens. (2004). An approach to drug induced delirium in the elderly. Postgrad Med J, 80, 388–393. Delirium in the Older Person: A Medical Emergency. Island Health Drugs that can cause delirium. Reviewed: 8-2014 www.viha.ca/mhas/resources/delirium/ Symptoms of an anticholinergic drug reaction Physical Symptoms Blurred vision Hot, dry skin / dehydration Dry mouth Shortness of breath Dilated pupils Increased heart rate Increased / decreased psychomotor activity Anorexia Urinary incontinence Hyperpyrexia Delirium in the Older Person: A Medical Emergency. Island Health Drugs that can cause delirium. Reviewed: 8-2014 Cognitive Symptoms Confusion / clouding of consciousness Memory impairment Visual hallucinations Sensory illusions Disturbance in sleep-wake cycle Disorientation, especially to time and place Incoherent speech Anxiety, agitation, excitement www.viha.ca/mhas/resources/delirium/