20 cards Flashcards
Initial investigation for mixed urinary incontinence
US bladder and pelvis- bladder wall thickness, detection of bladder diverticula, pelvic organ prolapse, measure post residual volume
First line pharmacological treatment for persistent orthostatic hypotension in older adults
Fludrocortisone - promotes sodium retention and plasma volume expansion. Contraindicated in HF and HTN. Evidence for benefit is low certainty esp in long term
Second line treatment for orthostatic hypotension
Midodrine - alpha 1 adrenergic agonist. Indications - for severe symptomatic orthostatic hypotension due to autonomic failure
SFX: HTN, urinary urgency
When would you use droxidopa?
Treatment of neurogenic orthostatic hypotension especially in Parksonson’s disease. Associated with supine HTN and HA
MOA: Converted to norepinephrine -> increases sympathetic tone -> increase BP
Cautions: careful in pts with CV disease, CI-pheochromocytoma
When would you use pyridostigmine
Orthostatic hypotension in autonomic failure
SFX: worsening urinary urgency
Desmopressin’s use in orthostatic hypotension
Specific cases esp nocturnal polyuria and/or morning orthostatic hypotension
MOA: Reduces urine output and expands plasma fume which therefore increases BP
Carries risk of hyponat in older adults- causes water retention without salt
Usuall given at night
How to manage incurable esophageal cancer and incapaciting dysphagia
Mesh stent
Characteristics of neuroleptic malignant syndrome
Fever, muscle rigidity, AMS, autonomic dysfunction - HTN, tachycardia, tachpnea
Management of neuroleptic malignant syhndrome
1.discontinue offending agent
2. supportive care- cooling and cold fluids
3. prevention of cx- thromboembolism, rhabdomyolysis, aspiration pneumonitis
4. R/O other ddx
Antidote: bromocriptine - has not been efficacous in trials although clinical experience supports use - consider if severe or prolonged - usually therapy done for 5-10 days via PO/NGT/orogastric tubs
SEDATION WITH ANTIPSYCHOTICS IS ABSOLUTELY CI
Sever, refractory cases consider dantrolene or ECT
Wearing off phenomenon in advanced Parksinson
Duration benefit from each levodopa dose becomes shorter
How to manage wearing off phenomenon in Parkionson disease
Reduce levodopa- carbidopa dose and give more frequently
Management of stridor in the context of neurodegenerative conditions
- CPAP initally to maintain upper airway patency, reduce WOB and provide symptomatic relief
Which Australian state is VAD illegal
NT
Minimum basic criteria for VAD
Patient must be over the age of 18
Be a resident of the state they are requesting VAD in for at least 12 months
Have decision making capacity for VAD
Are acting voluntarily and without coercion
Have an enduring request for VAD (i.e. their request is ongoing)
Have a disease, illness or medical condition that is, advanced and will cause death.
Disease is expected to or will cause death within six months, or 12 months if a person has a neurodegenerative condition (Victoria, Western Australia, South Australia, New South Wales, and Tasmania)
Causing suffering that cannot be relieved in a way that the person finds tolerable
Components of death certification
Auscultation of heart sounds for 5 min over multiple positions
Assessment of pupillary response to light
Observation for respiratory effort for 5 min - chest and abdo inspection for movement and breath sounds auscultation
Assessment of motor response to painful stimulus
Clin F of superior vena cava obstruction
Acute onset of breathlessness plus facial welling and stridor
Management of superior vena cava obstruction
Corticosteroids for symptomatic relief to reduce swelling -> oxygen therapy, consider anticoags to prevent thrombosis
Definitive treatment - radiotherapy, chemotherapy or endovascular stenting based on the underlying malignancy
Before acting on an advanced care directive you must
Confirm they remain current and applicable to the situation and discuss with the patient
What is the appropriate opiod PRN breakthrough dose
10% of the total regular opioid requirement over 24hours
