Geriatric medicine + Palliative Flashcards
Dementia pts class of medication
significantly associated with increase in mortality?
antipsychotics
Dx Dementia?
primary care
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
secondary care Dementia Dx
neuroimaging
medications associated with postural hypotension
antidepressants
ACEi
anticholinergic
beta blocks
diuretics
L-Dopa
Nitrates
medications associated with falls due to other mechanism?
benzo
antipsychotics
opiates
anticonvulsants
codeine
digoxin
Ix falls?
Bedside: basic obs, bp, blood glucose, urine dip, ECG
Bloods: FBC, U&E, LFT, Bone profile
Imaging: xray chest, CT head and cardiac echo
AD
pathophysiology
widespread cerebral atrophy
cortex and hippocampus
Huntingtons?
caudate nucleus and putamen
MS
white matter of the brain and spinal cord
Substantia nigra is impacted how in Parkinsons?
degeneration of dopaminergic neurons in substantia nigra
AD first line meds?
acetylcholinesterase inhibitors
Donepezil
Memantine and AD?
NMDA antagonist
2nd line
intolerant of acetylcholinesterase inhibitors
or if as an add on
Digoxin toxicity
narrow therapeutic index
GI disturbance, dizziness, confusion
Thiazodes like diuretics
indapamide can precipitate gout
confusion screen?
TSH
B12
folate and glucose
mx of delirium?
haloperidol / olanzapine
but in Parkinsons can worsen so maybe give quetiapine / clozapine
Delirium in PD management?
IM lorazepam
pressure ulcer treatment
do not routinely give abx
Waterlow score
screen for pressure ulcer
> bmi
> nutritional status
> skin type
> mobility
> continence
frailty assessment?
PRISMA-7
age,sex, health, help at home, mobility and social support
how can idiopathic PD dementia be differentiated to Lewy Body Dementia?
PD symptoms first
> dementia features
DLB management?
rivagstigmine
first line antipsychotic for delirium pts in palliative care?
haloperidol
Palliative care prescribing: agitation and confusion
haloperidol
chlorpromazine
In the terminal phase of the illness then agitation or restlessness is best treated
midzolam
Intracranial causes of nausea and vomiting
cyclizine first line anti emetic
Chemically mediated symtpoms of nausea
which anti emetic?
ondansetron
6 broad causes of N+V
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
pro kinetic agent?
domperidone preferred in
obstruction, GI perforation
Hiccups in palliative care?
chlorpromazine
> haloperidol/ gabapentin
Pain management in cancer
breakthrough dose?
1/6 of daily dose of morphine
severe renal impairment and pain mx?
alfentanil
buprenorphine
fentanyl
not renally excreted and so less likely to causes toxicity
hyoscine butylbromide
antimuscarinic drug
reduces smooth muscle contractions
tx for colicky pain
Pain relief in palliative care with severe renal impairment?
buprenorphine
starting morphine
20-30mg of MR with 5 mg morphone
when increaisng dose of opiods next dose should be?
30-50% more
conversion between opiods
50mg of codeine > morphine
0.5mg of morphine
oral tramadol to oral morphine?
divide by 10
from oral morphine to oral oxycodone?
divide by 1.5-2
oral morphine to subcut morphine?
divide by 2
oral morphine to subcut diamorphine?
divide by 3
oral oxycodone to subcut diamorphine?
divide by 1.5
when is syringe drivers used?
patient unable to take oral medication due to nausea
respiratory secretions are managed by?
hyoscine hydrobromide
glycopyrronium bromide
opiate toxicity is more commonly with?
morphine due to accumulation especially in chronic kidney disease
oxycodone / morphine / diamorphine in mild renal impairment?
oxycodone
painful mouth management
> end of life care
Benzydamine hydrochloride mouthwash
palliative patients with mild-moderate renal impairment ?
oxycodone
metabolised in liver
oral morphine to diamorphine?
/ 3
oral oxycodone to sub diamorphine?
/ 1.5
