Ageing Flashcards
anterior cerebral artery stroke
contralateral hemiparesis and sensory loss
lower > upper
middle cerebral artery stroke
contralateral hemiparesis and sensory loss
upper > lower
contralateral homonymous hemianopia
aphasia
posterior cerebral artery stroke
contralateral homonymous hemianopia with macular sparing
visual agnosia
Total anterior circulation infarcts sx
involves middle and anterior cerebral arteries
- unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
- homonymous hemianopia
- higher cognitive dysfunction e.g. dysphasia
Partial anterior circulation infarcts sx
involves smaller arteries of anterior circulation e.g. upper or lower division of middle cerebral artery
2 of the above criteria are present
Lacunar infarcts sx
involves perforating arteries around the internal capsule, thalamus and basal ganglia
presents with 1 of the following:
- unilateral weakness (and/or sensory deficit) of face and arm, arm and leg or all three.
- pure sensory stroke.
- ataxic hemiparesis
Posterior circulation infarcts sx
involves vertebrobasilar arteries
presents with 1 of the following:
- cerebellar or brainstem syndromes
- loss of consciousness
- isolated homonymous hemianopia
basilar artery stroke Sx
locked in syndrome
what is weber syndrome
branches of the posterior cerebral artery that supply the midbrain
ipsilateral CN III palsy
Contralateral weakness of upper and lower extremity
what is lateral medullary syndrome/Wallenberg syndrome
posterior inferior cerebellar artery
Ipsilateral: facial pain and temperature loss
Contralateral: limb/torso pain and temperature loss
Ataxia, nystagmus
70 year old taxi driver with trouble calculating change and with navigation - where is affected
parietal lobe
what is a common side effect of alpha blockers
postural hypotension
fall and syncope = DDx
arrthymia
orthostatic hypotension
vasovagal
valve disease i.e. aortic stenosis
what are common drugs that increase the risk of falls
BZDs antipsychotics antihypertensives antidepressants anticholinergics Class 1A antiarrthymias opiates diuretics parkisons medication
what is the intervention for falls with the most supportive evidence it works
Strength and balance training
Must be 3x week for minimum 12 weeks
being on how many drugs are considered a risk factor for falls
> 4
4 drugs that are frequently associated with adverse effects in the elderly
warfarin
digoxin
insulin
BZDs
side effects of NSAIDs
GI haemorrhage
decline in GFR
decreased effectiveness of diuretics, anti hypertensive agents
what anti-emetics cannot be used in parkinsons
prochlorperazine
metoclopramide
what can beta blocker not be prescribed with
verapamil
who can not get non-cardioselective beta blockers (e.g. propranolol, sotalol)
patients with COPD
who should CCB be stopped in
people with chronic constipation
what drugs do Potassium rich food [i.e. bananas,oranges, green leafy vegetables] interact with
ACEIs, ARBs, K-sparing diuretics
what drugs do food with lots of Vit E and K [Apples, chickpeas, spinach, nuts, spinach, kiwi, broccoli] interact with
Warfarin
what is important to note about these foods; Chicken, turkey, milk, soy,cheese, yogurt
alter PH
Interacts with: Antibiotics, thyroid meds, Digoxin, diuretics
what is the relation of Amitrytilline and BPH
makes it worse
there is a risk of urinary retention
what food/drink should you AVOID with a statin
grapefruit juice
what food/drink should you AVOID with metronidazole
alcohol
what food/drink should you AVOID with warfarin
cranberry
what food/drink should you AVOID with thyroxine
calcium
get decreased absorption
what drug should not be prescribed with warfarin
NSAID = risk of bleed
what would a combination of ACEi and spironolactone cause
Hyperkalaemia
what would a combination of digoxin and verapamil cause
digoxin toxicity
what would a combination of fluoxetine and phenelzine cause
serotonin syndrome
what conditions are Triptans contraindicated in
IHD
uncontrolled HTN
Lithium
SSRI
what antibiotics can not be given to someone on a statin
clarithromycin
what is the criteria for Delirium
Disturbance in attention
Change in cognition
Acute
Fluctuates
how does hypoactive delirium compare to hyperactive
hyperactive - agitation and restless
hypoactive - sleepy and slow
what are the hallmarks of Delirium
Acute and fluctuating
Inattention
Altered level of consciousness
Disorganised thinking
what is the 4AT
assessment test for delirium and cognitive impairment
what are the categories of 4AT and the points you can get in that category
Alertness [out of 4 points]
AMT4 [out of 2 points]
- [age, dob, place, current year]
Attention [out of 2 points]
- say months of the year backwards starting from December
Acute change or Fluctuating course [out of 4 points]
what are the score cut-offs for 4AT
4 or above = possible delirium +/- cognitive impairment
1-3 = possible cognitive impairment
0 = delirium unlikely
medication for Tx of delirium
Haloperidol
- 0.25-0.5mg PO, max 5mg a day
Quetipine
- for Parkinsons patients or Lewy Body Dementia
Lorazepam
- ONLY if alcohol or BZDs withdrawal
what score is used to assess risk of stroke in AF
CHA2DS2-VASc
Congestive HF Hypertension Age > 75 [2pts] Diabetes Stroke or TIA previously [2pts] Vascular disease Age 65-74 [1pt] Sex (female)
Score more than 1 = offer anti-coagulation
what are the options for anti-coagulation for AF
Warfarin
- INR target 2-3
NOACS
symptoms of opioid overdose
hallucinations, myoclonus, drowsiness
what is MR and what is it used for
Modified release (MR)
Background pain
Twice daily tablet
what is morphine IR and what is it used for
Immediate release (IR) Breakthrough pain
‘PRN’ tablet (sevredol) or liquid (oramorph) which is approx 1/6 of total background dose
Patient on Codeine 60mg four times a day (total daily dose 240mg) - what is the equivalent morphine dose
24mg morphine
divide by 10 = weak opiate
conversion factor for PO morphine to SC
Morphine is twice as potent given SC
To work out SC dose, divide PO dose by 2
Oral MST 10mg bd [20mg total] = SC morphine 10mg over 24 hours
what is common [anticipatory] prescribing for end of life
Pain / SOB = Morphine 2mg scut hourly
Distress = Midazolam 2mg scut
N/V = Levomepromazine 2.5mg eight hourly

Secretions = Hyoscine butylbromide injection (Buscopan® 20mg SC hourly
