Class 11

Question 1

PRINCIPLES OF DRUG THERAPY REASSESSMENT IN ELDERY

Answer 1

1. Indication of drugs
2. Recent modification to pharmacotherapy
3. Barriers to adherence
4. Adverse effects: Orthostatic hypotension, Posture and balance disorders, Falls and fractures, Delirium and cognitive disorders, Electrolytic disorders, Heart failure, Urinary incontinence, Fatigue, weakness, Anorexia and weight loss, Immobilization syndrome
5. Drug cascade
6. Drug interactions
7. Potentially inappropriate drugs: BEERS CRITERIA: TCA, benzos, anticholinergic drugs
8. Age-appropriate dosage: Patient weight, Serum creatinine, Patient nutritional status
   - Lower doses than adults
9. Prioritize interventions

Question 2

What non-medication interventions would you recommend to manage Delirium in hospital and to help prevent recurrence of Delirium once discharged

Answer 2

Nonetheless, an interdisciplinary approach to delirium should focus upon maintaining adequate hydration and nutrition, enhancing mobility and range of motion, treating pain and discomfort, preventing skin breakdown, ameliorating incontinence (seen in over half of delirious patients), and minimizing the risk of aspiration pneumonitis.
Mild confusion and agitation may respond to interpersonal and environmental manipulations. The hospital environment, characterized by high ambient noise, poor lighting, lack of windows, frequent room changes, and restraint use, often contributes to worsening confusion. Special units that address these concerns have improved the functional outcomes of hospitalization in such frail patients. Frequent reassurance, touch, and verbal orientation can lessen disruptive behaviors; family members or other familiar persons are preferred, but professional sitters can also be used to effect. Clock, calendar. Delusions and hallucinations should be neither endorsed nor challenged. . Make sure they use their glasses and hearing aides. Early screening. Lights opened and closed at circadian hours.

Question 3

Top 3 causes for delirium

Answer 3

Rx, UTI, respiratory infection

Question 4

Top 5 Rx cause delirium

Answer 4

benzos, , anticholinergics, zopiclone, steroids, opioids, antibiotics

Question 5

s/e antipsychotics elderly

Answer 5

Orthostatic hypotension, Anticholinergic effects, Metabolic effects, Extrapyramidal symptoms, Sedation, QTc prolongation

Question 6

How to differentiate vascular vs alzheimers

Answer 6

if slow steady progression = alzheimers, step wise decline = vascular

Question 7

If you treat mental health problems, decrease risk of alzheimers by

Answer 7

1.5-2 x

Question 8

When to use cholinesterase inhibitors

Answer 8

mild & moderate dementia, not mild cognitive impairment, can also treat agitation

Question 9

How to tell apart psychosis vs psychotic sx in dementia

Answer 9

in dementia more visual hallucinations, sundowning (more visual hallucinations and paranoia), stole things, someone came into house and moved my things.