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• W2023447906 abstract "Antipsychotics are frequently used for treatment of agitation in emergency departments (EDs). Current guidelines advocate the use of second generation antipsychotics (SGA) due to side effects associated with first generation antipsychotics (FGA). It is also recommended that oral medications be used whenever possible as it engages patients in their own treatment, avoids accidental needle sticks and may be potentially safer due to higher rates of respiratory depression and decreased oxygen saturation associated with some forms of IM SGAs. To evaluate the use of oral olanzapine (OZP), quetiapine (QTP), risperidone (RSP) and ziprasidone (ZPD) as well as alcohol intoxication, use of restraints, and adjunctive use of benzodiazepines in the ED setting. Change in systolic blood pressure (SBP), heart rate (HR), and oxygen saturation (SaO2) were also evaluated. This is a multicenter structured review of a retrospective cohort of patients over 7 years of patient visits at two general EDs. Patients receiving oral OZP, QTP, RSP or ZPD were evaluated and those with compete vital signs (SBP, HR & SaO2) recorded before and 4 hours after administration of SGAs were selected for inclusion. Variables extracted were patient age, vitals, use of benzodiazepines within 30 min of SGA, and alcohol intoxication. Vital signs prior to medication and the lowest values within 4h after were used for comparisons. Descriptive statistics are reported for mean change in SBP, HR and SaO2. Differences in mean change in vitals were evaluated with ANOVAs. A total of 852 patient visits were included (758 unique patients), average age was 44 (range 15-97) and 590 (69.2%) patients were male; 69.5% of patients received RSP, 24.3% OZP, 5.8% QTP and 0.5% 0% ZPD. Average decreases in vitals were: SBP 8.3 mm Hg, HR 5.8 bpm, SaO2 0.25% which is to be expected as patients calm. There were no significant differences in decreases in systolic BP between medications (F(3,848)=1.9, P=.13). Thirty-four (4%) of patients became hypotensive defined as SBP ≤ 95mmHg, consisting of 8.2% of QTP patients, 4.3% of OZP, 0% of ZPD, and 3.5% of RSP. Post-admin SaO2≤ 92% was seen only in 3 patients, all of whom had risperidone, and only 1 of whom had benzodiazepines. Adjunctive benzodiazepines were used in 190 (22.3%) cases at an average dose of 1.8mg of Ativan or its equivalent. Of the 34 patients with hypotension, only 7 received adjunctive benzodiazepines. Alcohol use was present in in 18.4% of QTP, 25% of ZPD, 11.8% of RSP, and 7.2% of OZP visits. Only 4 alcohol-using patients (2 OZP, 2 RSP) became hypotensive. The average BAL was 152 mg/dl with no significant differences between medication groups (F(3,570)=2.1, P=.11). Risperidone is the most frequently prescribed of oral SGAs in the ED setting. Oral SGAs are infrequently given to alcohol intoxicated patients. Oral SGAs are used with benzodiazepines >20% of the time. Average change in vital signs for oral SGAs are largely similar between groups." @default.
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• W2023447906 date "2014-10-01" @default.
• W2023447906 modified "2023-10-14" @default.
• W2023447906 title "393 Hypotensive Effects of Oral Second Generation Antipsychotics in the Emergency Department" @default.
• W2023447906 doi "https://doi.org/10.1016/j.annemergmed.2014.07.421" @default.
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