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Final Year - Passmed > Geriatric medicine + Palliative > Flashcards

Geriatric medicine + Palliative Flashcards

1
Q

Dementia pts class of medication

significantly associated with increase in mortality?

A

antipsychotics

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2
Q

Dx Dementia?
primary care

A

MMSE/ GPCOG

10-CS
6CIT

full blood screen
> Hypothyroid
>FBC, U&E, LFTs, Calcium, Glucose, ESR, CRP, TFTs, Vit B12, folate

> memory clinic referall
old age psych

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3
Q

secondary care Dementia Dx

A

neuroimaging

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4
Q

medications associated with postural hypotension

A

antidepressants
ACEi
anticholinergic
beta blocks

diuretics
L-Dopa
Nitrates

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5
Q

medications associated with falls due to other mechanism?

A

benzo
antipsychotics
opiates
anticonvulsants
codeine
digoxin

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6
Q

Ix falls?

A

Bedside: basic obs, bp, blood glucose, urine dip, ECG

Bloods: FBC, U&E, LFT, Bone profile

Imaging: xray chest, CT head and cardiac echo

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7
Q

AD
pathophysiology

A

widespread cerebral atrophy
cortex and hippocampus

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8
Q

Huntingtons?

A

caudate nucleus and putamen

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9
Q

MS

A

white matter of the brain and spinal cord

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10
Q

Substantia nigra is impacted how in Parkinsons?

A

degeneration of dopaminergic neurons in substantia nigra

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11
Q

AD first line meds?

A

acetylcholinesterase inhibitors

Donepezil

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12
Q

Memantine and AD?

A

NMDA antagonist
2nd line

intolerant of acetylcholinesterase inhibitors

or if as an add on

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13
Q

Digoxin toxicity

A

narrow therapeutic index

GI disturbance, dizziness, confusion

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14
Q

Thiazodes like diuretics

A

indapamide can precipitate gout

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15
Q

confusion screen?

A

TSH
B12
folate and glucose

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16
Q

mx of delirium?

A

haloperidol / olanzapine

but in Parkinsons can worsen so maybe give quetiapine / clozapine

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17
Q

Delirium in PD management?

A

IM lorazepam

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18
Q

pressure ulcer treatment

A

do not routinely give abx

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19
Q

Waterlow score

A

screen for pressure ulcer
> bmi
> nutritional status
> skin type
> mobility
> continence

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20
Q

frailty assessment?

A

PRISMA-7

age,sex, health, help at home, mobility and social support

21
Q

how can idiopathic PD dementia be differentiated to Lewy Body Dementia?

A

PD symptoms first
> dementia features

22
Q

DLB management?

A

rivagstigmine

23
Q

first line antipsychotic for delirium pts in palliative care?

A

haloperidol

24
Q

Palliative care prescribing: agitation and confusion

A

haloperidol
chlorpromazine

25
Q

In the terminal phase of the illness then agitation or restlessness is best treated

A

midzolam

26
Q

Intracranial causes of nausea and vomiting

A

cyclizine first line anti emetic

27
Q

Chemically mediated symtpoms of nausea

which anti emetic?

A

ondansetron

28
Q

6 broad causes of N+V

A

1- reduced gastric motility
5ht4 and dopamine receptor

2-chemically ; drugs
hypercalcaemia, opioids, chemo

3- visceral /serosal > constipation/ candidiasis

4- Raised ICP
5- Vestibular
opioid related

6- Cortical
> GABA/H1 receptors

29
Q

pro kinetic agent?

A

domperidone preferred in
obstruction, GI perforation

30
Q

Hiccups in palliative care?

A

chlorpromazine

> haloperidol/ gabapentin

31
Q

Pain management in cancer
breakthrough dose?

A

1/6 of daily dose of morphine

32
Q

severe renal impairment and pain mx?

A

alfentanil
buprenorphine
fentanyl

not renally excreted and so less likely to causes toxicity

33
Q

hyoscine butylbromide

A

antimuscarinic drug

reduces smooth muscle contractions

tx for colicky pain

34
Q

Pain relief in palliative care with severe renal impairment?

A

buprenorphine

35
Q

starting morphine

A

20-30mg of MR with 5 mg morphone

36
Q

when increaisng dose of opiods next dose should be?

A

30-50% more

37
Q

conversion between opiods

50mg of codeine > morphine

A

0.5mg of morphine

38
Q

oral tramadol to oral morphine?

A

divide by 10

39
Q

from oral morphine to oral oxycodone?

A

divide by 1.5-2

40
Q

oral morphine to subcut morphine?

A

divide by 2

41
Q

oral morphine to subcut diamorphine?

A

divide by 3

42
Q

oral oxycodone to subcut diamorphine?

A

divide by 1.5

43
Q

when is syringe drivers used?

A

patient unable to take oral medication due to nausea

44
Q

respiratory secretions are managed by?

A

hyoscine hydrobromide

glycopyrronium bromide

45
Q

opiate toxicity is more commonly with?

A

morphine due to accumulation especially in chronic kidney disease

46
Q

oxycodone / morphine / diamorphine in mild renal impairment?

A

oxycodone

47
Q

painful mouth management
> end of life care

A

Benzydamine hydrochloride mouthwash

48
Q
A

Final Year - Passmed (43 decks)

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