Ageing Flashcards
what is the criteria of the 4AT
alertness AMT4 - age, DOB, location, year attention acute change/fluctuating course
when is delirium typically worse
at night
what bloods are done in a confusion screen
normal bloods - FBC, U+E, LFT also - B12/folate - TFT - glucose - Bone profile (calcium)
how could you modify the environment of someone with delirium
quiet side room
familiar staff
visible clocks and calendars
1st line treatment of acute confusional state
Haloperidol
2nd line treatment of acute confusional state
lorazepam
acute confusional state in patient with parkinsons
lorazepam
2nd line acute confusional state in patient with parkinsons
quetiapine or clozapine
some medications that cause postural hypotension
Nitrates Diuretics Anticholinergic medications Antidepressants Beta-blockers L-Dopa ACEI
bedside tests for falls
basic obs LSBP ECG turn 180 test timed up and go test visual fields hearing test look at shoes
criteria of orthostatic hypotension
fall of SBP > 20 or DBP > 10 after 3 mins of standing
what are blood pressures taken in a LSBP
1st BP lying for 5 minutes
2nd BP standing for 1 minute
3rd BP standing for 3 minutes
what should you record in a LSBP aswell as blood pressure
any symptoms of light headed, palpitations, weakness, vision changes, pallor etc
what are some drugs to consider stopping in elderly in peptic ulcer disease
NSAIDs,warfarin and aspirin
what drug should be given in long term steroid treatment
bisphosphonates
when should a pressure ulcer be swabbed
only if evidence of surrounding cellulitis
how long does dementia have to be going on for in order to diagnose
6 months
most common dementia
alzheimers
dementia with stepwise progression and CVS risk factors
vascular
do people with vascular dementia tend to lose insight?
no vascular dementia insight usually spared
what can be used to differentiate Alzheimers from vascular
hackinski score
dementia with fluctuating symptoms with lucid periods and recurrent visual hallucinations
lewy body
dementia associated with parkinsons
lewy body
how do parkinsons and lewy body differ
parkinsons - parkinson symptoms first, cognitive at least a year after
lewy body - cognitive symptoms first or at same time as parkinsonism
tx lewy body dementia
low dose levodopa
dementia with younger onset and personality changes and change in eating habits
frontotemporal
is insight spared in frontotemporal dementia
no tends to be lost early
inheritance of huntingtons
autosomal dominant
tx severe alzheimers
memantine
tx mild - moderate alzheimers
Rivastigmine, Donepazil, Galantamine
what kind of drugs are Rivastigmine, Donepazil, Galantamine
ACh esterase inhibitors
what kind of drug is memantine
NMDA antagonist
what is the triad of huntingtons
emotional, cognitive and motor disturbance
what is the motor disturbance in huntingtons
choreiform movements
potentially reversible cause of dementia with urinary incontinence, ataxia and cognitive impairment
normal pressure hydrocephalus
tx of normal pressure hydrocephalus
VP shunt
rapid onset of dementia in < 50s with ataxia, seizures, myoclonic jerks
mad cow disease
cognitive assessment in dementia (3)
MMSE
MOCA
ACE III
agitation and confusion treatment in terminal phase
midazolam
hiccups treatment in terminal phase
chlorpromazine
secretions treatment in terminal phase
hyoscine hydrobromide/butylbromide
sore mouth treatment in terminal phase
benzydamine hydrochloride
1st line nausea and vomiting treatment due to reduced gastric motility
metoclopramide - if not risk of SEs
domperidone
nausea and vomiting that is chemically mediated e.g. post chemo
metoclopramide - if not at risk of SEs
ondansetron
what GI situation should you avoid metoclopramide
post-gastric surgery bowel obstruction (but helpful in paralytic ileus)
what side effect of metoclopramide is particularly apparent in children and young people
EPSEs - oculogyric crisis
Nausea and vomiting due to intracranial disease treatment
cyclizine
headache/raised ICP from intracranial disease treatment
dexamethasone
vestibular causes of nausea and vomiting treatment
cyclizine
breakthrough dose of morphine calculation
1/6 daily dose
oral codeine to oral morphine
/ 10
oral morphine to SC morphine
/ 2
oral morphine to SC diamorphine
/ 3
how much should opiate be increased if increasing dose
by 30-50%
opioid of choice in mild- moderate renal disease
oxycodone
opioid of choice in severe renal disease
buprenorphine or fentanyl
oral morphine to oral oxycodone
divide by 1.5 - 2
oral oxycodone to SC diamorphine
divide by 1/5
max number of medications in a syringe driver
3
commonly used N+V drug in syringe driver
levomepromazine
tx bowel colic in end of life care
hyoscine butylbromide
4 main anticipatory drugs in end of life care
levomepromazine
hyoscine butylbromide
midazolam
diamorphine
death verification - 6 steps
- Check for spontaneous movement, including respiratory effect
- Check for reaction to voice and pain – sternal rub or supraorbital nerve
- Palpate at least 2 major pulses for one minute
- Inspect the eyes looking for dryness, fixed dilated pupils, absence of corneal reflexes and clouding of the cornea
- Auscultate the heart and lungs for one minute
- Remember to note if pacemaker/implantable device is present
reversal of opioid toxicity
naloxone
s/s opioid toxicity
jerky movements, myoclonus pin point pupils reduced resp rate drowsy hallucinations
tx breathlessness in palliative care
oral opioid
tx anxiety related breathlessness
lorazepam
