Elderly - 1

Question 1

Principles that reduce drug-related morbidity & mortality

Answer 1

• Only when absolutely needed, use drug.
  -Avoid, if possible, a1-adrenoceptor blockers, drugs with anticholinergic effects, very sedative or long half-life or inhibitors of hepatic metab. enzymes
  -start low, and go slow
  -Don’t treat S.E with another drug
  -Keep therapy simple (one dose between than BID)

Question 2

Covert use of medicine (in foodstuff) in dementia allowed only …

Answer 2

full discussion with MDT
recording
only if in patients benefit

Question 3

does the literature support the use of ginkgo Biloba in cognitive impairment and dementia…

Answer 3

Not much.
But it is safe.

Question 4

What is Huperzine A?

Answer 4

an alkaloid isolated from the chinese her huperzia serrata
Highly selective, reversible ACHE-I

Question 5

literature on Huperzin A for AD?

Answer 5

a meta-analysis showed it led to significant. improvement on MMSE and ADL
Later, this result were replicated

Question 6

literature on Efficacy of saffron (crocus sativus) in AD

Answer 6

supported by meta-analysis and systematic review
on adas-cog and other scales

Question 7

which new parental treatment is under investigation for vascular dementia?

Answer 7

Cerebrolysin

Question 8

what is cerebrolysin?

Answer 8

porcine brain-derived peptide preparation that has pharmacodynamic properties similar to those of endogenous neurotrophic factors.

Question 9

——— consumption is shown in longitudinal studies to be assocaited with lower risk of cognitive impairment (adjusted for confounders). (moreira et al 2016)

Answer 9

Chocolate

Question 10

% of completed suicides that occur in elderly?

Answer 10

20%

Question 11

What do meta-analysis say about elderly response to antidepression compared to younger adult?

Answer 11

51%
Similar
(MPGIP 14th)

Question 12

Most toxic TCAs in elderly

Answer 12

Doxepin
Amitriptyline
(Seizure and cardiac arrhythmia)

Question 13

Toxic effects of TCA in elderly?

Answer 13

Seizure and cardiac arrhythmia

(Doxepin & Amitriptyline)

Question 14

Possible exception to general safety of SSRIs in elderly?

Answer 14

Citalopram

(minor metabolite can cause QTc- prolongation)

Question 15

SSRIs that can cause weight gain in elderly

Answer 15

Paroxetine
Citalopram

Question 16

Most sedative SSRI in elderly?

Answer 16

Paroxetine
Fluvaxamine

Question 17

antidepressant class that can cause interstitial lung diseases?

Answer 17

SNRIs

Question 18

What antidepressant can cause cognitive impairment in elderly that begins with T

Answer 18

Trazodone

Question 19

NaSSa class antidepressant that cause problematic weight gain in elderly?

Answer 19

Mirtazapine

Question 20

Is there an ideal antidepressant for the elderly ?

Answer 20

nope

Question 21

Older people are particularly prone to develop 1- ———— 2————– 3———– and 4 ———due to SSRIs.

Answer 21

1- Fall
2- Postural hypotension
3- Hyponatraemia
4- Haemorhagic stroke

Question 22

Ranking of antidepressant safety and tolerability in the elderly?

Answer 22

• SSRIs (watch out for GI bleeding in hx of bleeding, NSAIDs, warfarin)
  -Agomelatine ( watch out for LFT)
  -Vortioxetine & Duloxetine for those not suitable for SSRIs due to their caveats

Question 23

1st line treatment for behavioural and psychological symptoms of dementia (BPSD) in the elderly (MPGIP 14th)

Answer 23

Evidence-based, multicomponent non-drug measures, which are personalised and involve working closely with care-givers

Question 24

example of 1 evidence based non pharma therapy for behavioural and psychological symptoms of dementia (BPSD)

Answer 24

music therapy (MPGIP 14th)

Question 25

what are Multicomponent interventions

Answer 25

They use a comprehensive, integrated multidisciplinary approach combining medical, psychiatric and nursing interventions may be more effective at reducing severe behavioural problems in nursing home patients.

Question 26

The antipsychotic that is licensed for persistent aggression in AD

Answer 26

Risperidone

Question 27

True or false

Antipsychotics should not be used routinely to treat agitation and aggression in people with dementia.

Answer 27

True

Question 28

when can analgesics be used for aggression & agitation in dementia?

Answer 28

when there is a complete assessment of pain
Following up the effectiveness
Usually choose paracetamol (worth a trial even in overt pain)

Question 29

which FGA is not recommended in BPSD

Answer 29

Haloperidol

Question 30

Regime for Risperidone in BPSD ?

Answer 30

Dose range: 0.25–2mg/day
Reduce by 0.25–0.5mg every 1–2 weeks (depending on dose), then stop

Question 31

clinical benefit of AChE-Is and memantine in BPSD?

Answer 31

Unclear

Question 32

studies suggest cholinesterase inhibitors are more effective for 1——–, 2——–, 3——– and 4——–symptoms.

Answer 32

depression
dysphoria
apathy
anxiety

Question 33

SSRI with strongest evidence in a RCT for BPSD?

Answer 33

Citalopram?

Question 34

The preferrable point about sertraline in comparison to citalopram?

Answer 34

it’s cardiac safety

Question 35

Max dose of agomelatine in elderly

Answer 35

50 mg at night or evening

Question 36

Min dose of agomelatonine in elderly

Answer 36

25 mg

Question 37

max dose of citalopram in elderly

Answer 37

20 mg at morning

Question 38

min dose of citalopram in elderly

Answer 38

10 mg at morning

Question 39

melatonin max and min dose in elderly

Answer 39

2 mg prolonged release at night