For Student

An 84-year-old man is agitated and restless.

The patient is disturbing other residents in the residential care home. He has a history of cardiac
and cerebrovascular disease with vascular dementia. The on-call doctor who attends prescribes
haloperidol 2.5 mg stat and then 1 mg three times a day to follow.

Tasks:
1. What iatrogenic illness may result from the given intervention?
Task 1 (3.0) Short-term side effects may include hypotension, sedation and immobility,
increasing the risk of dehydration, poor nutrition and pressure sores. If continued for more
than several days, there is a risk of drug-induced parkinsonism and falls. If continued long
term, there is an increased risk of stroke, accelerated cognitive decline and continued
parkinsonism. Mortality is increased when neuroleptics are continued long term in such
situations
2. What risk factors for iatrogenic illness are present in this case?
Task 2 (2.0) Age,
cardiac disease and
vascular brain disease increase the risk of adverse events
3.Suggest some alternative management strategies.
Task 3 (2.0) If the agitation and restlessness are of recent onset, this is hyperactive delirium and
there are underlying causes, such as infection, pain, discomfort or metabolic disturbance. Such
precipitants should be carefully identified and treated as appropriate.

Non-pharmacological means to settle the patient’s agitation should be tried, including

reorientation, the calming presence of a family member or familiar carer, encouraging the patient
to wear his glasses and hearing aid if required, and hydration. Every opportunity to avoid
pharmacological sedation should be considered.

4. How can these complications be minimized?

Task 4 (3.0) If sedation is required, then the initial dose of haloperidol should be kept low (1 mg
initially); if necessary, a further dose can be given 20–30 min later. Follow-on medication should
be given only if necessary, and in this situation should be low dose (0.5 mg twice a day).
Treatment should not be continued beyond 3 days and should never be continued indefinitely. If
the patient has pre-existing parkinsonism, a small dose of lorazepam 0.5–1 mg can be considered
as an alternative.