GERATOLOGY

Question 1

medication classes that commonly cause constipation (3) and some examples of each

Answer 1

1. opiates e.g. oxycodone, morphine
2. CCBs e.g. nifedipine, amlodipine, felodipine
3. antipsychotics e.g. clozapine, haloperidol, chlorpromazine

Question 2

1st line management of delirium

Answer 2

antipsychotics e.g. haloperidol

Question 3

1st line management of delirium if pt has background of parkinsons

Answer 3

lorazepam

Question 4

causes of delirium (PINCH ME)

Answer 4

Pain
Infection
Nutrition
Constipation
Hydration

Medications - opioids, benzos
Environment

Question 5

what makes a diagnosis of postural hypotension?

Answer 5

from sitting to standing within 10 minutes - systolic BP drops by =>20mmHg and/or diastolic BP drops by =>10mmHg

Question 6

what drugs frequently cause postural hypotension?

Answer 6

• antihypertensives e.g. ramipiril
• diuretics
• L-dopa
• antidepressants
• sedatives
• alpha blockers e.g. sildenafil

Question 7

non-pharm causes of postural hypotension

Answer 7

1. hypovolemia
2. autonomic dysfunction - diabetes, Parkinson’s
3. alcohol

Question 8

management of postural hypotension
a) non-pharm
b) pharm

Answer 8

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)

Question 9

list some neuropsychiatric causes of falls in the elderly

Answer 9

1. visual impairment
2. hearing impairment
3. peripheral neuropathy
4. gait issues e.g. PD
5. cognitive impairment
6. stroke/TIA

Question 10

list some toxic/environmental causes of falls in the elderly

Answer 10

1. meds - BBs, diabetic meds, antihypertensives, benzos, abx
2. polypharmacy
3. substance misuse e.g. alcohol
4. environmental hazards e.g. loose rugs, uneven floors, living alone

Question 11

list some cardiovasc causes of falls in the elderly

Answer 11

1. syncope
2. orthostatic/postural hypotension
3. carotid sinus syndrome

Question 12

list some MSK causes of falls in the elderly

Answer 12

1. instability/poor mechanical mobility
2. arthritis
3. reduced muscle strength
4. obesity

Question 13

which tests can be done at the bedside to assess gait and balance abnormalities after a fall?

Answer 13

turn 180 test
timed up and go test

Question 14

assessment tool for distinguishing between dementia and delirium in hospital

Answer 14

confusion assessment method (CAM)

Question 15

define delirium

Answer 15

a syndrome of clouding of consciousness, disorientation, perceptual impairment and changes in affect and behaviour

Question 16

reversible causes of dementia (5)

Answer 16

1. b12 deficiency
2. thiamine deficiency
3. hypoglycaemia
4. normal pressure hydrocephalus
5. hypothyroidism

Question 17

drugs causing urinary incontinence

Answer 17

1. diuretics e.g. furosemide, bendroflumethiazide
2. sedatives e.g. opiates, antipsychotics

Question 18

RFs for urinary incontinence (6)

Answer 18

1. pregnancy
2. childbirth
3. obesity
4. chronic constipation
5. chronic cough
6. post-menopause (reduced oestrogen)

Question 19

drugs causing urinary retention

Answer 19

1. anticholinergics e.g. oxybutynin
2. NSAIDs

Question 20

supportive measures for stress incontinence

Answer 20

pelvic floor exercises, avoid caffeine, avoid/stop smoking, lose weight

Question 21

mechanism of action of duloxetine in stress incontinence

Answer 21

SNRI - increased noradrenaline at synapse, this increases tone of internal urethral sphincter