Elderly Care Flashcards

Question

Describe what causes drug induced Delirium

Answer 1

Anti-parkinsonian drugs- anti-cholinergic or dopaminergic effects Analgesia- except paracetamol Anti-Psychotics- sedating ones- chlorpromazine Benzodiazepines- more common on initial treatment Diuretics- due to electrolyte balance Long acting oral hypoglycaemics- glibenclamide can cause hypoglycaemia and hyponatraemia Aminophylline and digoxin- NTI- check levels Tricyclic anti-depressants - anti-cholinergic and sedative effects Steroids- dose related risks- hallucinations common

Answer 2

Alcohol (common) Benzodiazepines Opioids Drugs of abuse (cocaine, amphetamines)

Answer 3

Confusion assessment method It is delirium based on: Acute onset and fluctuating course Inattention Disorganised thinking Altered level of consciousness

Answer 4

Treat underlying medical cause Review medications Adapt environment if necessary Ensure regular personal orientation- clocks, calendar, window Use all aids- glasses and hearing aids Continuity of care Encouragement of mobility Maintaining good fluid intake Reviewing old age psychiatry services Last choice- sedative use to control behaviour

Answer 5

Last resort, short term (1 week or less): - Haloperiodol 0.5mg to 1mg up to 2 hourly PRN (off license) - Olanzapine 2.5mg to 5mg up to TDS PRN (off license) - Can be given IM or PO, more potent when given parenterally - Lorazepam 0.5mg to 1mg up to BD PRN (off license) - If haloperidol or olanzapine contraindicated due to parkinsons disease or lewy body dementia Reason to use: Aim to calm the patient not sedate them Risks vs benefits need to be considered Associated with unrelieved pain, treat any reversible causes, trial of haloperiold or leveomepromazine

Answer 6

``` Main changes: Cataract Macular degeneration Glaucoma Retinal disease Dry eyes ``` ``` Leads to: Decline in visual activity Difficulty seeing in glare Difficulty in dark adaptation Narrowing of visual field ```

Answer 7

Develop due to oxidative damage to lens Impaired transmission of light to retina Risk factors: - Diabetes - Smoking - UV light exposure - Use of corticosteroids Resolved surgically with artificial lens

Answer 8

Leading cause of blindness Two forms: Progressive dry form- small granular deposits in retina Aggressive wet form- new weakly blood vessels form in macula which lead to distorted vision- treatment with anti-VGEF drugs injected into virtual cavity- Ranibizumab Risk factors: Smoking Female gender

Answer 9

Optic neuropathy due to raised intra-ocular pressure Leads to loss of visual field Symptoms arise when irreversible damage has occurred ``` Risk factors: Increasing age Afro-carribean ethnicity Family history Myopia- short sighted Diabetes Use of long term corticosteroids ```

Answer 10

Open angle: Drainage angle for aqueous fluid is open but fluid drains too slowly through the meshwork meaning intraocular pressure rises Narrow and closed angle: Drainage angle for aqueous fluid is narrow or closed completely by part of the iris Patients are at risk of sudden spikes in intra-ocular pressure that require emergency treatment- spikes associated with sudden onset of pain, nausea and blurred vision Aims: Reduce rate of aqueous humour production Increase rate of outflow

Answer 11

Prostaglandin analogues- increased outflow on aqueous fluid- OD- Latanoprost, Travoprost, Bimatoprost Side effects: Local increased eyelash growth and iris pigmentation Beta blockers- reduced production on aqueous fluid- OD to BD- Timolol, Carteolol Side effects: local irritation, systemic bradycardia and bronchoconstriction Alpha-agnost- increased outflow and reduced production of aqueous fluid- BD to TDS- Brimonidine, Dorzolamide Side effects: local irritation, redness, systemic fatigue, dizziness and dry mouth Miotics- increase outflow- BD to TDS- Pilocarpine- Local headache and poor vision, twitching eye, lacrimation Osmotic diuretics- increase outflow by osmotic diuresis- IV- mannitol, glycerol- hypotension

Answer 12

Inadequate perfusion of the eye leading to new vessel formation and oedema leading to retinal damage Decreased corneal sensation, leads to dry eyes and corneal ulcers Increased risk of cataracts and glaucoma at younger age Treatment None other than try and preserve function with good glycemic control Risk factors: Poor glycemic control Long standing diabetes Co-morbidies (hypertension)

Answer 13

Very common Results in irritation which paradoxically causes watering Symptoms= burning sensation or sensation of foreign body Causes: drugs like anticholinergics, irritant eye drops, parkinson's disease (reduced blinking), rheumatological conditions, Sjorgen's syndrome (immune system attacks salivary glands and tear glands- treat with pilocarpine) Treatment: Use preservative free eye drops Avoid anticholinergics where possible Use topical lubricant eye drops- hypromellose, carbomer

Answer 14

- Incontinence= unintentional passing of urine - More common in women Stress incontinence: spontaneous loss of urine not associated with urge to urinate- when coughing or laughing Urge incontinence: spontaneous loss of urine with an intense urge to urinate Chronic retention: inability to pass full bladder of urine Acute retention: abrupt inability to pass any urine (emergency) More common in men Happens due to: urethral blockage, drugs (anticholinergics), BPH (most common)

Answer 15

Life style changes Pelvic floor exercises Bladder training Incontinence products: Overactive bladder: - Oxybutynin, tolterodine or darifenacin are first line - Mirabegron (Beta 3 adrenoceptor agonist) is used when unable to take antimuscarinic drug) - Botox injection into bladder wall is option if oral option doesn't work - Various surgical techniques- last line

Answer 16

Licensed alpha blocker like tamsulosin High risk BPH patients, consider 5-alpha reductase inhibitor like finasteride to reduce risk of progression to cancer Catheterisation if necessary- temporary or permanent

Answer 17

Dysphagia secondary to stroke- Nasogastric or PEG tube Drug- feed interactions like phenytoin Tablet/capsule: liquid conversions Dexterity-can they open a click bottle, pick up very small tablets or read label Compliance aids- dosette box, alarmed box, PD medication alarm Rationalised medications Safe use of warfarin and NOACs Use of patient decision aids in making evidence based choices