When administering medications to patients with dementia or delirium it is important to have an understanding of what dementia and delirium means. Delirium is an acute reversible state of disorientation and confusion. Delirium is marked by disorientation without drowsiness, hallucinations, delusions; difficulty in focusing attention; inability to rest and physical and autonomic over activity. Common causes of delirium are drug and alcohol withdrawal; medication side effects, infections, pain surgery or trauma, hypoxia, and acid-base electrolyte imbalances. Treatment of delirium includes determining the cause of the delirium. Antipsychotic drugs and benzodiazepines may be used cautiously when other non-pharmacological interventions have failed. (Tabors 2009)
Dementia is a progressive irreversible decline in mental function marked by memory impairment and often deficits in reasoning, judgment, abstract thought registration, comprehension, learning, and use of language. Symptoms may take months to years to progress and they include poor judgment, clouding of consciousness and orientation, depression, agitation sleeplessness, Patient may become dependent of activities of daily living. Dementia may result from AIDS, chronic alcoholism, Alzheimer’s disease, vitamin B12 deficiency, carbon monoxide poising, hypothyroidism and subdural hematomas. 4.5 million People in the U.S are affected by dementia. 20-40% of patients with dementia are over the age of 85. (Tabor’s 2009)
Some of the most common drugs used to treat dementia are Tacrine (Cognex), Donepezil (Aricept), Rivastigmine (Exelon), and Galantamine (Razadyne). When administering these medications to a patient it is important to remember that each patient is different and you have to customize the way you care for each individual patient. A physician may write an order that states, “May crush appropriate medications and place in suitable vehicle to facilitate administration.” This order allows for easier administration of the medications because it gives the nurse more options. (Work experience)
Tacrine (Cognex) is dispensed in capsules that are not extended release which would allow the nurse to open the capsule and easily mix the medication with food or drinks. Donepezil (Aricept) is dispensed in an oral disintegrating tablet which is beneficial because the tablet dissolves rapidly in the patient’s mouth or in a suitable vehicle i.e. (pudding, yogurt, applesauce, juice). Rivastigmine (Exelon), is dispensed in many forms such as a capsule, oral solution or a transdermal patch which is very beneficial because the nurse has the option to administer the drug in a way that works best for the patient. Galantamine (Razadyne) is dispensed in an extended release capsule, oral solution and immediate release capsule. With this drug the nurse’s options are limited because the extended release can not be crushed or chewed. Other options would need to be considered with the physician if the patient needed crushed medications.( Drug Guide 2009)

References
Venes, Donald. (2009). Tabor’s Cyclopedic Medical Dictionary. Dementia /Delirium. Philadelphia: F.A. Davis Company.

Deglin, H. Judith & Vallerand, H. April. (2009)Davis Drug guide for Nurses eleventh edition. Philadelphia: F.A. Davis Company.