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Australian Journal of Pharmacy : October 2006
education counselling casebook • approved CPE not advocated. It may exacerbate cognitive impairment and increase the risk of falls. Some aged care homes are now employing diversional therapists in late afternoon to increase activities. Use of risperidone for BPSD: Common adverse effects include postural hypotension especially early in treatment, tachycardia, insomnia, agitation, anxiety, headache, akathisia and hypoprolactinaemia. Weight gain, constipation, extrapyrimidal side effects are uncommon in lower doses. The potential risk of cerebrovascular adverse events with risperidone was raised by an Australian trial in which cerebrovascular adverse events (mainly strokes and transient ischaemic attacks) occurred in 1.8 per cent of people in the placebo group and in 9 per cent in the risperidone group.9 patients who experienced cerebrovascular adverse events All CPE POINTS (b) Depression affects about 16 per cent of adults at some point in their life. (c) Anxiety disorders affect about 10 per cent of adults at some point in their life. (d) Up to 1 per cent of people affected by mental illness commit suicide. (e) Some people experience their mental illness only once and then fully recover. 2. (a) Typical antipsychotic agents produce adverse effects such as extrapyrimidal effects and have strong anticholinergic properties. (b) Haloperidol is a second generation atypical antipsychotic (c) Aripiprazole is not approved for the management of behavioural disturbances in dementia. (d) Risperidone is approved for the management of behavioural disturbances in dementia. (e) Olanazepine is not approved for the management of behavioural disturbances in dementia. 3. (a) Restraint is the act of removing another person’s freedom. (b) Restraint may be considered to prevent a resident falling at the request of family. (c) A family member or legal representative has legal power to require that a resident be restrained. (d) A medication used to sedate a person causing disruption without a medical cause can de defined as chemical restraint. 82 ? THE AUSTRALIAN JOURNAL OF PHARMACY VOL.87 OCTOBER 2006 prophylaxis in this resident? The response to risperidone comes in one-to-two weeks but it takes two-to-three months for the full trial. Once stablised, Eleanor may be able to have once daily dosing.16 Review: Regularly review the need for continuing therapy with a view to reducing the dose or ceasing. Behavioural disturbances may be short-lived, so drug therapy should not be prescribed indefinitely. Minimising drug exposure is important to limit the risk of adverse effects.6 Members of the Australian College of Pharmacy Practice and Management may gain half (0.5) a credit point by either answering questions directly online at www.acp.edu.au or forwarding the answers to: ACPP, PO BOX 7007, CANBERRA BC ACT 2610 or fax to (02) 6273 8988 by the 25th of the month following the month of issue. All but one of the following statements are true. Which statement is false? Answers will be listed on www.acp.edu.au in due course. 1. (a) 20 per cent of Australian adults are affected by mental illness at some time in their life. (e) Sitting a resident in a bean bag may be termed physical restraint. 4. (a) Altered behaviour in a patient with dementia may be the result of an intercurrent illness. (b) Low-dose atypical antipsychotic medication in patients with agitated or aggressive behaviour is unlikely to assist management. (c) There is low evidence for the use of anticonvulsants in patients whose dementia is complicated by behavioural problems. (d) There is some evidence for the use of typical antipsychotics in the treatment of psychotic symptoms win persons with dementia. (e) Drugs with anticholinergic properties, for example, oxybutynin, may cause behavioural problems in older people. 5. (a) If an antipsychotic drug is prescribed to control behaviour problems in a patient with dementia, its use should be reviewed as the dementing condition changes. (b) Risperidone may cause postural hypotension early in treatment. (c) The risk of cerebrovascular adverse events was shown to be higher with risperidone than placebo in some trials. (d) Risk factors such as hypertension, diabetes, atrial fibrillation may increase the risk of cerebrovascular events. (e) Risperidone should always be dosed twice a day. AJPCPE CONTINUING PROFESSIONAL EDUCATION had significant risk factors, such as hypertension, atrial fibrillation and diabetes mellitus.9 In six placebo-controlled trials in mainly elderly people with dementia, cerebrovascular adverse events occurred in 3.3 per cent (33/989) of patients treated with risperidone and 1.2 per cent (8/693) of patients treated with placebo.15 Is there a need for thrombo-