drugs commonly producing delirium
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Etiology
- drugs with anticholinergic activity#
- see drugs with anticholinergic activity for relative potencies
- parasympatholytics
- neuroleptics with anticholinergic activity[2]
- chlorpromazine
- thioridazine
- antipsychotics (MKSAP19)[10]
- no increased risk[3]
- antidepressants with anticholinergic activity
- histamine H2 receptor antagonists with anticholinergic activity
- uncertainty regarding H2-receptor antagonists (GRS9)[5]
- should be avoided in older adults (GRS9)[5]
- cimetidine has 86% of anticholinergic activity of atropine
- narcotic analgesics*
- sedative-hypnotics
- benzodiazepines*
- Parkinsonian agents
- dopamine agonists (pergolide, bromocryptine)
- diuretics
- antiarrhythmics
- anti-inflammatory agents
- anticonvulsants
- general anesthetics
- depth of anesthesia is risk factor [4.5]
- alcohol
- fluoroquinolones[10]
# most common in elderly[2]
* drugs most associated with delirium were opioids, benzodiazepines, dihydropyridines, & possibly, antihistamines[3]
- only antihistamine specifically implicated is diphenhydramine (GRS9)[5]
* prehospital statin therapy with continued statin therapy during hospitalization may diminish risk of delirium in critically ill elderly[7][8]
Additional terms
References
- ↑ Francis J, J Am Geriatric Soc 40:829, 1992
- ↑ 2.0 2.1 2.2 Geriatrics at Your Fingertips, Reuben et al (eds) American Geriatrics Society, Excerpta Medica, Belle Mead, NJ, 2001
- ↑ 3.0 3.1 3.2 Clegg A, Young JB. Which medications to avoid in people at risk of delirium: a systematic review. Age Aging 2011; 40:23-29. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21068014
- ↑ Sieber FE, Zakriya KJ, Gottschalk A et al Sedation depth during spinal anesthesia and the development of postoperative delirium in elderly patients undergoing hip fracture repair. Mayo Clin Proc. 2010 Jan;85(1):18-26. Erratum in: Mayo Clin Proc. 2010 Apr;85(4):400. Dosage error in article text. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20042557
- ↑ 5.0 5.1 5.2 5.3 Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016 - ↑ Kalisch Ellett LM, Pratt NL, Ramsay EN, et al. Multiple anticholinergic medication use and risk of hospital admission for confusion or dementia. J Am Geriatr Soc. 2014;62(10):1916-1922 PMID: https://www.ncbi.nlm.nih.gov/pubmed/25284144
- ↑ 7.0 7.1 Morandi A, Hughes CG, Thompson JL et al Statins and delirium during critical illness: a multicenter, prospective cohort study. Crit Care Med. 2014 Aug;42(8):1899-909. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24810528 Free PMC Article
- ↑ 8.0 8.1 Page VJ, Davis D, Zhao XB Statin use and risk of delirium in the critically ill. Am J Respir Crit Care Med. 2014 Mar 15;189(6):666-73. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24417431 Free PMC Article
- ↑ 9.0 9.1 Rothberg MB, Herzig SJ, Pekow PS et al Association between sedating medications and delirium in older inpatients. J Am Geriatr Soc. 2013 Jun;61(6):923-30. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23631415
- ↑ 10.0 10.1 10.2 Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022