cote Flashcards
how to treat delirium acutely?
haloperidol 0.5mg
nice says haloperidol or olanzipine
would you use benzos in delirium?
no, make delirium worse
what causes alzheimer’s
extracellular amyloid plaques in hippocampus, temporal and parietal lobesq
what would you see on mri of alzheimers?
bilateral hippocampal and temporal lobe atrophy
what would you see on ct/mri of vascular dementia?
areas of new/old infarct
widespread white matter change due to small infarcts
what would frontotemporal dementia look like on mri?
asymmetrical atrophy of hippocampus, amygdala, temporal lobes
what causes frontotemporal dementia
atrophy of frontal and anterior temporal lobes
pick bodies (tau)
what causes lewy body dementia?
lewy bodies in substantia nigra and cerebral cortex
may also see some amyloid plaques
how is lewy body dementia treated?
acetylcholinesterase inhibitors
donepezil
rivastigmine
galantamine
2nd line
memantine (NMDA)
can you give antispsychotics in lewy body dementia?
no, rigidity and akinesia!
what is the effect of dopamine agonists in lewy body?
psychiatric side effects such as confusion, hallucinations
what is first line medication for alzheimers?
achesterase inhibitors
donepezil
rivastigmine
galantamine
what side effects need to be monitored in achesterase inhibitors?
cholinergic side effects
what is second line tx for az dementia
memantine
how to treat behavioural/psych problems of dementia?
haloperidol
risperidone
antidepressants
how is vascular dementia treated?
manage RFs treat htn statins antiplatelets smoking cessation
how is lewy body dementia treated?
ach inhibitors then memantine like alzheimers
levodopa for movement dis
clonazepam for REM sleep
avoid using haloperidol as serious side effects
can use antidepressants
how is frontotemporal dementia treated?
antidepressants
antipsychotics (rarely)
what sort of therapy for dementias?
cognitive stimulation therapy to improve memory and problem solving skills
why might you get AKI in a patient who has fallen?
fallen for a long time - muscle breakdown (rhabdomyolysis) causes AKI
check U&E
also pressure sores
does advanced directive have to be written?
not unless life-sustaining treatment
can patient request treatment on advanced directive?
no, can only refuse
maximum dols?
12 months
who needs to be present in dols?
imca
