COTE Flashcards
What medications might someone with IHD be on
Aspirin Colpodogrel Statin ACEi B blocker Nitrate CCB
Name 5 geriatric giants
Falls Incontinence Confusion Urinary symps Chest pain+ SOB
What is meant by deconditioning
Process of physiological change following a period of inactivity. It results in functional losses in areas such as mental status, abilities to accomplish ADL.
What are the 4 key areas of assessment in the GCA
Medical
Psychological
Functional
Social and environmental
Three drugs for OAB
Fesoterodine
Tolterodine
Oxybutanin
Tx for nocturia
Desmopressin
Tx of urgency incontinence
Bladder training
Avoid caffeine
Tx of stress incontinence
Wt loss
Decrease caffeine
Bladder diary
Pelvic floor exercises
What are the 4 types of incontinence
- Stress incontinence I.e when sneezing
- Functional (not GU)
- overflow/ over active bladder (OAB) commonly with prostatic enlargement
- urgency incontinence (bladder size shrinks)
Treatment of overflow incontinence in BPH
Finasteride (it raises PSA)
Tamulosin
Symptoms of overactive bladder
F- frequency
U-urgency
N- nocturia
Cardiovascular causes of falls
Carotid sinus hypersensitivity
Vasovagal hypersensitivity
Orthosatic hypoT
Arrhythmia
Non cardiac causes of falls in the elderly
Iatrogenic
Vision
Gait problems
Fear of falling
What medications commonly cause falls
Benzos, antipsychotics , antiepileptics, antidepressants, sedatices, antihypertensives, pain killers I.e. codiene.
What issues might older people have with exercise regimens ?
Cognitive impairment may hinder adherence
How might orthostatic hyperT be treated
Medication review Hydration Salt intake Education / life style advice I.e. get up slow OT - home risk assessment I.e rugs
Side effects of an ACEi
Cough
Dizziness
Rash / red itchy skin
Side effects of thiazides diuretics
Dizziness/ lightheaded
Blurred vision
Loss of appetite
Upset tummy
Side effects of antibiotics
Diarrhoea
N&V
Bloating and indigestion
What blood would your order for a dementia screen
LFT TFT Ca++ Glucose FBC(anaemia) B12 Folate
What are the different types of dementia
Alzheimer’s
Vascular/mixed
Dementia w/ lewybodies
Frontotemporal
What is the common clinical presentation of someone with vascular dementia
Step wise decline
Gait and balance problems +cog decline
Associated with microhaemorrhages + mini cortical strokes
Problem with retrieval not laying down memories
What is the common clinical presentation of Lewy body dementia
Parkinson plus’s syndrome
Hallucinations
Cog impairment
Common clinical presentation of frontotemporal dementia
Marked executive function decline -I.e. in planning
Often lack insight
Name 4 cognitive assessment tools
MMSE
MOCA
6cit
GPCOG
Pathological features of Alzheimer’s
Cortical atrophy
Intracellular NF tangles
Extra cellular plaques
Accumulation of beta amyloid peptide (due to degradation of APP)
Define dementia
Chronic progressive neurodegen’ disorder not a normal part of the aging process
irreversible changes in brain pathology
Characterised by memory loss and impairment to ADL.
Bio markers of AD
Hyperphos tau in CSF
Increased A-beta42
Diagnostic criteria for AD
Progressive decline in memory and functioning for 6months +
Episodic memory test provides objective evidence
Alzheimer’s exclusion criteria
Gait problems (vascular)
Hallucinations (Lewy body)
Another medical condition can explain symps
Sudden onset
AD mimics
Major depression.
Severe cerebrovascular disease
Metabolic disorders
Other dementias
What speech change might you see in AD
Semantically empty speech
Frequent intrusions
Repetitive errors
What staging is used in AD
Braak staging for spread of amyloid pathology
What investigations would you do in AD
And what would they show
Bloods
MRI- cortical atrophy
PET- APP degradation and beta amyloid accumulation
CSF sample - hyperphos tau
Episodic memory test - freq intrusions + repetition errors
Medication for dementia
ACEi
Rivastigmine
Donepazil
Galantamine
Protection from excess glutamate = memantine
Two drug classes for treating Alzheimer’s
1) ACEI
2) NMDA receptor antagonist
Name an NMDA receptor antagonist used to treat Alzheimer’s
Memantine
Causes of behavioural and psychological symptoms of dementia (BPSD)
“Pinch me”
Pain Infection Nutrition Constipation Hydration Medication Environment
Key feature of lewybody dementia
Visual hallucinations
Key features of CJD dementia
Rapid progression (weeks to months) Motor symps- eventually unable to move and speak Mood changes
Key features of Frontotemporal dementia
Personality changes I.e. Apathy, lack of empathy, reduced humour, impulsive
Key features of Alzheimer’s
Short term memory loss Forgetting names/ events/ conversations/ appointments Getting lost Losing items Word finding difficulties
Most common over 65
Key features of Parkinson dementia
Emotional liability
Must have had motor symptoms 1year prior
Key features of vascular dementia
Step wise deterioration
Change in executive function I,e, planning
Vascular history
Which two dementias should you not give antipsychotics in
Lewy body dementia
Parkinson dementia
SE of thiazide diuretics in elderly
Hyponatremia = orthostatic hypertension
Drug interactions to avoid
ACEI and allopurinol Thiazide diuretics and amiodarone Warfarin and clarithromycin Statins and grapefruit Methotrexate and trimethoprim
Complications post stroke
VTE Post stroke pain Malignancy MCA syndrome Seizures Aspiration pneumonia
What investigations might you do post stroke
USS Doppler carotids
Echo
ECG / 24hours tape
MRI
What is the secondary prevention Tx for stroke in AF
Stop anticoagulants (doac/ warfarin) transiently, aspirin for 14 days, start back on anticoagulant
When can you give aspirin and clopidogrel post stroke
After 24hour CT following thrombolysis
Or straight away if no thrombolysis
What is the management plan for someone coming in via ambulance ? Stroke
CT head - no haemorrhage and under 4 hours = thrombolyse Statin 24hour CT Aspirin and clopi
Why is LMWH contraindicated in high risk strokes
Risk of haemorrhagic transformation
What is AF caused by MV pathology called
Valvular AF
treatment of ischemic stroke + DVT/PE
LMWH
Example of LMWH
Dalteparin
Example of DOAC
Apixaban / riveroxiban
Causes of parenchymal haemorrhagic stroke
Trauma
Hypertension
Malignancy
Management of parenchymal haemorrhagic stroke
Lower bp- labetalol
Tranexamic acid
Reverse anticoags (octaplex/ vitk)
Refer to neurosurgeon
Cause of SAH
AVM
Berry aneurism
Investigations for SAH
CT angiogram
LP
ECG- inverted Twaves ?ischemia
Vasospasm tx
Nimlodipine
