GERATOLOGY Flashcards
medication classes that commonly cause constipation (3) and some examples of each
- opiates e.g. oxycodone, morphine
- CCBs e.g. nifedipine, amlodipine, felodipine
- antipsychotics e.g. clozapine, haloperidol, chlorpromazine
1st line management of delirium
antipsychotics e.g. haloperidol
1st line management of delirium if pt has background of parkinsons
lorazepam
causes of delirium (PINCH ME)
Pain
Infection
Nutrition
Constipation
Hydration
Medications - opioids, benzos
Environment
what makes a diagnosis of postural hypotension?
from sitting to standing within 10 minutes - systolic BP drops by =>20mmHg and/or diastolic BP drops by =>10mmHg
what drugs frequently cause postural hypotension?
- antihypertensives e.g. ramipiril
- diuretics
- L-dopa
- antidepressants
- sedatives
- alpha blockers e.g. sildenafil
non-pharm causes of postural hypotension
- hypovolemia
- autonomic dysfunction - diabetes, Parkinson’s
- alcohol
management of postural hypotension
a) non-pharm
b) pharm
a) compression stockings, high salt diet, advice on knowing the signs and standing slowly
b) stop/decrease causative med
or fludrocortisone (e.g. if not due to med)
list some neuropsychiatric causes of falls in the elderly
- visual impairment
- hearing impairment
- peripheral neuropathy
- gait issues e.g. PD
- cognitive impairment
- stroke/TIA
list some toxic/environmental causes of falls in the elderly
- meds - BBs, diabetic meds, antihypertensives, benzos, abx
- polypharmacy
- substance misuse e.g. alcohol
- environmental hazards e.g. loose rugs, uneven floors, living alone
list some cardiovasc causes of falls in the elderly
- syncope
- orthostatic/postural hypotension
- carotid sinus syndrome
list some MSK causes of falls in the elderly
- instability/poor mechanical mobility
- arthritis
- reduced muscle strength
- obesity
which tests can be done at the bedside to assess gait and balance abnormalities after a fall?
turn 180 test
timed up and go test
assessment tool for distinguishing between dementia and delirium in hospital
confusion assessment method (CAM)
define delirium
am acute, transient syndrome of clouding of consciousness, disorientation, perceptual impairment and changes in affect and behaviour
reversible causes of dementia (5)
- b12 deficiency
- thiamine deficiency
- hypoglycaemia
- normal pressure hydrocephalus
- hypothyroidism
drugs causing urinary incontinence
- diuretics e.g. furosemide, bendroflumethiazide
- sedatives e.g. opiates, antipsychotics
RFs for urinary incontinence (6)
- pregnancy
- childbirth
- obesity
- chronic constipation
- chronic cough
- post-menopause (reduced oestrogen)
drugs causing urinary retention
- anticholinergics e.g. oxybutynin
- NSAIDs
supportive measures for stress incontinence
pelvic floor exercises, avoid caffeine, avoid/stop smoking, lose weight
mechanism of action of duloxetine in stress incontinence
SNRI - increased noradrenaline at synapse, this increases tone of internal urethral sphincter
palliative care management - secretions
1st line = hyoscine hydrobromide or hyoscine butylbromide
can also use glycopyyronium bromide
palliative care management - pain
- oral modified-release morphine
- immediate-release morphine for breakthrough pain
- laxatives for SE
palliative care management - breathlessness
- OPIOIDS e.g. oramorph or morphine sulphate SC (if severe CKD, start at lowest dose, consider oxycodone 1st line)
- if associated with anxiety give LORAZEPAM SL
palliative care management - agitation
benzos
- lorazepam SL
- diazepam PO
- midazolam SC
opioid of choice in palliative patients with CKD
- if mild-moderate, oxycodone preferred
- if severe, alfentanil/buprenorphine/fentanyl
palliative care management - hiccups
options are
- chlorpromazine
- haloperidol
- gabapentin
non-medical management options for preventing future falls in the elderly (4)
- strength and balance training
- home hazard assessment
- medication review
- vision assessment
cause of brown-red urine in rhabdomyolysis
myoglobinuria
common osteoporotic facture locations
- hip
- distal radius
- vertebrae
- humerus
instructions for how to take bisphosphonates and some common SEs
instructions:
- take with lots of water
- take whole
- stay upright for 30 mins after
SEs:
- abdo pain
- dyspepsia
- nausea
- abdominal distension
