Geriartic Medicine Flashcards
Addenbrooke’s Cognitive Exam-3 (ACE-3)
Out of 100, pt scores 68. There is a global deficit in all domains tested in the ACE-3.
Which dementia is it?
Alzheimer’s Dementia produces global deficits on the Addenbrookes Cognitive Exam
ACE Scale suggests dementia if the score is?
A score of 82 or less strongly suggests dementia.
what are the domains of ACE?
domains tested are Memory, Attention, Fluency, Language and Visuospatial.
PEOPLE WITH ALZHEIMER’S dementia have a global deficit which means?
all 5 domains mein masla Hai
frontotemporal dementia will show deficits
in fluency and language
Vascular dementia deficits will depend on
previous stroke
no consistent pattern seen in ACE-3 examinations.
Mild cognitive impairment
An ACE-3 score of 82-88 suggests MCI.
Parkinson’s dementia
deficits in the visuospatial domain as well as memory and attention.
In view of dementia, which medication should you consider stopping?
TCA;Amitriptyline
worsens Dementia
assessment tools recommended by NICE for the non-specialist setting include:
10-point cognitive screener (10-CS), 6-Item cognitive impairment test (6CIT)
In dementia cases it is important to rule out a primary/organic causes with certain test;
FBC, U&E, LFTs, calcium, glucose, TFTs, vitamin B12 and folate levels.
Neuroimaging is performed* to exclude other reversible conditions (e.g. Subdural haematoma, normal pressure hydrocephalus)
oral modified-release morphine should be used in preference to transdermal patches
if no comorbidities use 20-30mg of MR a day with 5mg morphine for breakthrough pain
what is preferred to morphine in palliative patients with mild-moderate renal impairment
Oxycodone
and with severe renal impairment?
alfentanil, buprenorphine and fentanyl are preferred
elderly agitated pts
which drug is first choice and 2nd choice
1; haloperidol
2; chlorpromazine an dlevomepromazine
elderly agitated pts with cancer(but not in terminal phase/EOL)
which drug is first choice and 2nd choice
1; haloperidol
2; chlorpromazine an dlevomepromazine
a woman has breast cancer mets gone to ribs and pelvis.Pain is not controlled with analgesia and bisphosphonates has caused arthralgia and myalgia.
What is the next best option?
To increase MST(analgesia) and go for radiotherapy.
Metastatic bone pain may respond to analgesia, bisphosphonates or radiotherapy
Dexamethasone should be considered if there is metastatic spinal cord compressions.
Management of hiccups
chlorpromazine is licensed for the treatment of intractable hiccups
haloperidol, gabapentin are also used
dexamethasone is also used, particularly if there are hepatic lesion
Bleomycin belongs to which Onco drug group?
Bleomycin is a cytotoxic antibiotic used to treat metastatic germ cell cancer, squamous cell carcinoma and in some regimes non-Hodgkin’s lymphoma.
