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Evaluating the Risks of Second Generation Antipsychotic Use in Elders with Dementia

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   Dementia develops in 5-8% of adults over the age of 65 years and 25-50% of those over 85 years of age. In addition to a progressive decline in cognition and functioning, patients commonly exhibit behavioral and psychological symptoms of dementia (BPSD). These include physical or verbal aggression, wandering, restlessness, anxiety, depression, sleep disturbance, and psychotic symptoms such as hallucinations and delusions. BPSD contributes substantially to patient distress and caregiver burden, and can result in institutionalization of the patient. Up to 90% of demented patients in nursing homes exhibit BPSD.

   Strategies to address BPSD include non-drug management, antipsychotics, cholinesterase inhibitors, antidepressants, antiepileptics, and benzodiazepines. Among these options, second generation antipsychotics (SGAs) are widely used, although none have been FDA approved for this indication and there are serious safety concerns linked with their use. This issue summarizes the limited efficacy and tolerability of SGAs when they are used in demented older adults. Detailed explanations of the increased risk for stroke, death, tardive dyskinesia and pneumonia that are associated with SGAs are provided. Ways to minimize adverse effects are discussed along with a comprehensive list of recommendations for non-drug approaches to assist patients with BPSD. Improving quality of care in this vulnerable population requires that healthcare providers be fully cognizant of the risks and benefits of treatment and that patients’ caregivers are making fully informed decisions about using these medications.


Publication Date: 05/01/2009
Expiration Date: 05/31/2012
CE Credit: 1.5 (0.15 CEU)
Type of Activity: Knowledge-based

This program was developed by The Rx Consultant and published by Continuing Education Network, Inc. The Rx Consultant accepts no advertising or financial support from the pharmaceutical industry and is funded solely by the purchase of programs. The Rx Consultant is dedicated to providing unbiased, balanced information to health care practitioners.

Programs developed by The Rx Consultant are written by health care providers with expertise in the topic area, peer-reviewed, extensively edited, and fact-checked. This development process was created to insure that every program presents information that is current, accurate, relevant to "real world" health care providers, and written in an easy reading, "plain English" style.


Tami L. Remington, Pharm.D., Clinical Associate Professor, College of Pharmacy, University of Michigan; and Clinical Pharmacist, UM Turner Geriatric Clinic, Ann Arbor, MI. Trisha D. Wells, Pharm.D., Clinical Assistant Professor, College of Pharmacy, University of Michigan and Clinical Pharmacist, UM Health System, Ann Arbor, MI.

Disclosure Statement

Remington and Dr. Wells report no financial or personal relationship with any commercial interest producing, marketing, reselling, or distributing a product or service that appears in this issue.

Target Audience

This accredited program is targeted to pharmacists .

Goals & Objectives

At the conclusion of this program, participants will be able to:

    1. Describe the impact of BPSD on patients and caregivers
    2. Characterize the potential benefits of antipsychotic medications in treating BPSD.
    3. Identify major risks of antipsychotic medications in demented older adults, citing actual rates of these events observed in clinical trials or observational studies.
    4. Assist patients and families to ensure the decision to initiate treatment is an informed one.
    5. Work with patients, families and other health care providers to monitor for and minimize the risk for serious adverse events linked with antipsychotic use.

Accreditation Statements

The Rx Consultant is a publication of Continuing Education Network, Inc.

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Continuing Education Network, Inc. is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education as a provider of continuing pharmacy education.

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Continuing Education Network is approved by the California Board of Registered Nursing, Provider Number CEP 13118. Programs approved by CA BRN are accepted by most State Boards of Nursing.

ACPE Universal Activity Number: 0428-0000-09-008-H01-P

Exam & Credit Statement Procedures

Upon successful completion of this program and the post test (70%), 1.5 hours of continuing education credit will be awarded. To receive credit and your exam score, please complete the exam questions and program evaluation.

Editorial and Review Board

Chief Editor and CE Administrator

Terry M. Baker, PharmD

Managing Editor

Tracy Farnen, PharmD

Associate Editors

James Chan, PharmD, PhD
Pharmacy Quality and Outcomes Coordinator
Kaiser Permanente
Oakland, CA

Associate Clinical Professor
School of Pharmacy
University of California San Francisco
San Francisco, CA

Richard Ron Finley, B.S. Pharm.,R.Ph.
Clinical Pharmacist (volunteer faculty)
University of California, San Francisco (UCSF) Memory and Aging Center
Lecturer (Emeritus) UCSF, Department of Clinical Pharmacy
Health Sciences Clinical Professor, UCSF School of Pharmacy
San Francisco, CA

Consultant Pharmacist
Ray Dolby Brain Health Center, Sutter Health/CPMC
San Francisco, CA

Consult Pharmacist Aging and Adult Health Services
San Francisco Health Department
San Francisco, CA

Julio R. Lopez, PharmD, FCSHP
Chief of Pharmacy Service
VA Northern California Health Care System

Adjunct Clinical Professor
College of Pharmacy
Touro University
Vallejo, CA

Assistant Clinical Professor
School of Pharmacy
University of California, San Francisco
San Francisco, CA Adjunct Professor
Thomas J. Long School of Pharmacy
University of the Pacific
Stockton, CA

Visiting Associate Professor and Lecturer
Nursing School
Samuel Merritt University
Oakland, CA

Pamela Mausner, MD

Helen Berlie, Pharm.D. CDE, BCACP
Clinical Assistant Professor, Pharmacy Practice
Wayne State University
Detroit, MI

Ambulatory Care Specialist - Diabetes
Health Centers Detroit Medical Group
Detroit, MI

Senior Editorial Advisor

Gerard Hatheway, PharmD, PhD

Editorial Advisors

Belinda M. Danielson, RPh
Christopher M. DeSoto, PharmD
Angie S. Graham, PharmD
Cynthia Chan Huang, PharmD, MBA
Fred Plageman, PharmD

Editorial Advisor and Clinical Practice Consultant for Nurse Practitioners

Emily K.
Meuleman, RN, C, MS

About the Rx Consultant

The Rx Consultant is a monthly publication dedicated to providing health care professionals with the information they need to educate patients about drugs and manage drug therapy. The reader is responsible for confirming the information presented here and interpreting it in relation to each patient's specific situation before utilizing the information.

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