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Haldol, Pneumonia, PD

Posted

Why on earth would any one consider giving Haldol to an elderly patient with Parkinson's disease admitted for Pneumonia???? Just because he/she is confused/agitated!!

VANurse2010

Has 6 years experience.

If the person is a danger to themselves or others, that would be an indication for an antipsychotic.

Because Haldol is a first-line treatment for acute delirium (I hope it was a low dose, though). Thank goodness whoever was doing the ordering knew better than to give her a benzo for the agitation and confusion, which would make the delirium worse.

MunoRN, RN

Specializes in Critical Care. Has 10 years experience.

Because outcomes for untreated hospital delirium are far worse than when it's treated. And it's cruel to leave it untreated, it's very distressing and traumatic for the patient.

Haldol isn't recommended for elderly people with Parkinson's!

Haldol isn't recommended for elderly pts with Parkinson's!

True to a certain extent. But it isn't an absolute contraindication. It is a relative contraindication.

Relative contraindications

Special caution is advised in the presence of the following conditions:

  • Parkinson's disease or dementia with Lewy bodies
  • Patients at risk of QT prolongation, a rare heart condition that increases the risk of arrhythmia originating in the ventricles
  • Impaired liver function (the metabolism of haloperidol is mainly hepatic)
  • In epileptic patients, haloperidol can reduce the threshold at which a convulsion may occur

  • The effects of haloperidol are stronger in patients with hyperthyroidism and there is an increased risk of side effects in this patient group
  • The intravenous administration of haloperidol injection can lead to postural hypotension and collapse

According to the American Parkinson's disease Association, Haldol use should be avoided in eldery.

MunoRN, RN

Specializes in Critical Care. Has 10 years experience.

Parkinson's is a relative contraindication for haldol, not an absolute contraindication. Haldol should be avoided whenever possible in both the elderly and PD patients, and should not be a scheduled medication but only PRN and after other non-medical interventions have failed, but there are still times where the need for symptom management exceeds the risks.

MunoRN, RN

Specializes in Critical Care. Has 10 years experience.

According to the American Parkinson's disease Association, Haldol use should be avoided in eldery.

In general, all medications should be avoided in everyone whenever possible. Sometimes medications are needed despite attempts to avoid them.

According to the American Parkinson's disease Association, Haldol use should be avoided in eldery.

There are a lot of meds that "should" be avoided but are prescribed because the benefits outweigh the risk.

Penelope_Pitstop, BSN, RN

Has 13 years experience.

Take my opinion with a grain of salt...but Seroquel is probably a better choice for delirium in this population; however, Seroquel can't be given IV or IM. It's fine if you have an OG, NG or PEG, but if it has to be given PO to a delirious person, that just might not work.

Wile E Coyote, ASN, RN

Specializes in Critical care.

Take my opinion with a grain of salt...but Seroquel is probably a better choice for delirium in this population; however, Seroquel can't be given IV or IM. It's fine if you have an OG, NG or PEG, but if it has to be given PO to a delirious person, that just might not work.

Geodon (given IM) is our preferred alternative to haldol. Getting it ordered instead of haldol is another fight all together, however.

qnmimi

Specializes in Med/Surg crit care, coronary care, PACU,. Has 30 years experience.

Snarky nurse says: because said doctor is not educated enough to know that haldol is contraindicated in parkinson's, and confusion is a symptom of pneumonia, with associated multifactoral delerium. Sorry, had to get that out.

Snarky nurse says: because said doctor is not educated enough to know that haldol is contraindicated in parkinson's, and confusion is a symptom of pneumonia, with associated multifactoral delerium. Sorry, had to get that out.

Hmmm...not sure what you are trying the say here!

Penelope_Pitstop, BSN, RN

Has 13 years experience.

Geodon (given IM) is our preferred alternative to haldol. Getting it ordered instead of haldol is another fight all together, however.

Does Geodon have any demonstrated effectiveness in delirium though?

I've been out of MICU for over a year now but our choices for ICU psychosis/delirium were Haldol, Seroquel and Zyprexa.

Interestingly enough (or actually not interesting at all!) I work psych currently and while the vast majority of my patients are on anti-psychotics, I don't have anyone with PD, and (I'm outpatient/community) if someone walks into my office with delirium, I'm sending him or her to the ED, so I don't treat delirium anymore either...