Activity Dates: 04/21/2009 - 04/21/2012
This course is closed. Please look for other available products in CPNP University.
If you are a pharmacist, nurse practitioner or other healthcare professional involved in the comprehensive medication management of psychiatric and/or neurological patients, we invite you to participate in this online course.
Delirium is a state of acute confusion resulting from a general medical condition that can last from hours to months, often fluctuates in severity and presentation, and may include a variety of psychiatric symptoms. It is particularly common in the elderly and those with pre-existing cognitive impairment or brain injury. Delirium is a predictor of multiple adverse outcomes, including functional and cognitive decline, increased length of hospitalization, and mortality.
Acetylcholine deficits have been proposed as the final common pathway to delirium by some investigators, but the pathophysiology of delirium is not well understood. Despite this uncertainty, it is clear that anticholinergic drugs can cause or contribute to delirium. Multiple challenge studies, epidemiologic studies, and studies examining serum anticholinergic activity in delirium provide evidence in this regard. People with dementia are highly susceptible to the cognitive and psychiatric adverse effects of anticholinergics and may experience cognitive symptoms and behavioral disturbances as a result of anticholinergic exposure.
The primary treatment for delirium is to correct the underlying cause and provide a safe and supportive environment while it resolves. Antipsychotics are the mainstay of symptomatic treatment, though adverse effects need to be considered in high risk populations such as those with dementia. Pharmacists can help manage and prevent delirium by reviewing medications and recommending discontinuation of drugs that might be contributing to cognitive impairment. Prior studies have shown that anticholinergic medications are frequently prescribed to people with dementia. Given that these patients have a high risk of experiencing delirium and are sensitive to these medications, efforts to eliminate anticholinergic prescribing in this group may help reduce the burden of delirium.
You will proceed through the following steps to satisfactorily complete this course:
This course is provided online at cpnp.org and consists of the speaker audio and slides. A PDF file of the slides is also provided and access is available to participants indefinitely although ACPE credit is available only through the course expiration date.
Participants in this course must complete an examination and achieve a score of 60% or greater. Successful completion of the course also requires the completion of a course evaluation. ACPE statements of credit can be retrieved by participants online at cpnp.org immediately upon successful completion of the course.
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Ryan Carnahan, MS, PharmD, BCPPView biographical information and disclosures
The College of Psychiatric and Neurologic Pharmacists is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. This self-study course provides 1.0 contact hours (0.1CEUs) of knowledge-based continuing education credit from CPNP approved programming. The ACPE universal program number assigned to this course is 0284-0000-09-011-H01-P (1.0 contact hours).
ACPE approved contact hours are accepted for ANCC Certification Renewal (see pages 5 and 6): At least 50% (37.5 hours) of your 75 continuing education hours must be formally approved continuing education hours. Formally approved continuing education hours meet one or more of the criteria listed below:
Off-Label Use: This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA (see faculty information and disclosures). The opinions expressed in the educational activity do not necessarily represent the views of CPNP and any educational partners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Disclaimer: Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Presentation-Specific Disclosure: Antipsychotics and cholinesterase inhibitors for delirium or neuropsychiatric disturbances in dementia patients. May include any drug in these classes.
This programming was supported in part by grants from Bristol-Myers Squibb, Forest Laboratories, Inc., Lilly, Schering-Plough, Cyberonics, and Shire.