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GSTDY > Geriatric Syndromes > Flashcards

Geriatric Syndromes Flashcards

1
Q

Syndrome

A

A group of signs and symptoms that occur together

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2
Q

4 domains in Geriatric syndrome

A

1- cognitive function
2-motor function
3- sensory function
4-psychosocial function

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3
Q

5 areas of motor functions

A 
Muscle strength 
Reflexes
Coordination
Voluntary control of body functions 
Gait/ balance
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4
Q

5 psychosocial functions

A 
Appetite
Sleep/wake
Personality
Behavior
Mood/Ideation
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5
Q

5 sensory functions

A 
Vision
Smell
Hearing
Taste
Touch
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6
Q

5 cognitive functions

A 
Memory
Insight/ interpretation 
Orientation/ level of consciousness 
Attention/ concentration 
Problem solving/ decision making
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7
Q

Define geriatric syndrome

A

Clinical
Multifactorial health conditions that DO NOT FIT into specific disease categories, impact Multiple domains and are associated with Morbidity and Mortality

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8
Q

Name 8 things that cause BLADDER Issues

A

DIAPPERS

  • Delirium
  • Infection ( uti)
  • Atrophic ( urethritis or vaginitis)
  • Pharmacology ( diuretics, ACheI- acetylcholine esterase inhibitors and alcohol causes increase urination); alpha blockers ex:doxazosin cause stress incontinence in women because it FURTHER DILATES the Urethra which causes pressure to cause a leakage.; antimuscarinics cause a ⬇️ in urination
  • Psychological ( depression, dementia)
  • Excessive urine output ( CHF, diabetes , edema) CHF ⬆️ urination
  • Restricted mobility ( wheelchair bound and immobile) is a functional incontinence
  • Stool impaction -the rectum is parallel with urethra; Stool in rectum can pinch of urethra and cause urinary RETENTION
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9
Q

Incontinence

A

Involuntary loss of urine or bowel

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10
Q

5 precipitating causes of incontinence

A

1-Urge incontinence
Ex: overactive bladder, inappropriate filling which ⬆️ urgency
2-Stress incontinence
There is an ⬆️or⬇️ pressure on bladder neck which causes a leak during exercise or cough
3- Overflow incontinence
- consistent with BPH in men or anything that BLOCKS URETHRA in women
4-Mixed incontinence
- involves any of the 1st 3 causes
5-functional incontinence
- older adults have difficulty getting to bathroom

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11
Q

First line of therapy for incontinence involving bladder

A

Do not use medication

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12
Q

Name 5 non pharm treatment to stress incont

A 
Weight loss 
Kegel exercise
Pads
Pessaries
Surgery
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13
Q

Name 4 non pharmacological tx for Urge incontinence

A

Weight loss
Kegel
Pads
Fluid reduction

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14
Q

4 non pharmacological tax of overflow incontinence

A

Pads
Fluid reduction
TED hose
Catheter

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15
Q

Non Pharmacological tx for Mixed incontinence

A

Treat predominant type

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16
Q

4 non pharmacological tx for functional incontinence

A

Schedule voiding
Prompted voiding( reminding patient)
Commode
Grab bars

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17
Q

2 Drugs that treat bladder incontinence ( stress)

A

SNRI - duloxetine ; (approve in Europe not in US;MOA -⬆️norepinephrine can reduce stress incontinence)
Alpha agonist like sudafed but not recommended

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18
Q

3 Drugs that treat bladder incontinence ( urge)

A

Antimuscarinics ( anticholinergics)- acetylcholine causes contraction of Bladder detrusor muscle which causes a release of urine. Blocking acetylcholine with antimuscarinics ⬇️ Bladder detrusor muscle contraction responsible for overactive bladder
B3 agonist - stimulation of beta-3 causes RELAXATION of bladder muscle
Botox- causes relaxation

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19
Q

What effect does acetylcholine have on bladder

A

Increases urination

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20
Q

Name 5 anticholinergics( antimuscarinics )drugs use to treat URGE incontinence

A 
Detrol- tolTERODENE
Toviaz- fesoTERODINE
Sanctura -trospium
Vesicare- soliFENACIN
Enablex-dariFENACIN
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21
Q

Another name for urge incontinence

A

Overactive bladder

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22
Q

Name 1 beta 3 agonist to treat URGE

A

Myrbetriq- mirabegron it doesn’t go through anticholinergic pathway

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23
Q

3 drug classes to treat overflow incontinence( BPH)

A

Alpha blockers
5 alpha reductive inhibitors
PDE-5 inhibitors

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24
Q

MOA of alpha-1 blockers

A

They limit prostate enlargement ( in BPH the prostate enlarge and cause a blockage of urethra

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25
Q

Name alpha-1 blockers to treat BPH

A 
alfuZOSIN- Uroxatral- selective
doxaZOSIN-Cardura
teraZOSIN-Hytrin
tamsulOSIN- Flomax- selective and 1st line treatment 
silodOSIN-rapaflo- selective
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26
Q

Difference between selective and non selective alpha blockers

A

Selective alpha-1 blockers are better because they prevent dizziness caused by non selective

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27
Q

Name (2) 5 alpha reductase inhibitors to treat overflow incontinence

A

dutASTERIDE-Avodart

finASTERIDE-Proscar

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28
Q

What is PDE-5 inhibitor,it’s MOA, and which one has been approved for both BPH and sexual erectile dysfunction.

A

Phosphodiesterase inhibitor. PDE breaks down cGmp. cGMP is responsible for smooth muscle relaxation through the depletion of calcium out of the cell which results in increase blood flow. PDE-5 inhibits the action of PDE.

Tadalafil ( cialis) is the only drug approved for both BPH and sexual dysfunction

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29
Q

Medication for Mixed urinary incontinence

A

Treat predominant cause

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30
Q

MOA of antimuscarinics in urge incontinence

A

⬇️detruser muscle contraction

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31
Q

Name 4 meds that can cause constipation

A

Opioids
Calcium channel blockers
AntiCHOLINERGICS
iron supplements

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32
Q

3 medical conditions that can cause constipation

A

Cancer
HYPOthyroidism
Neurological disorders like Parkinsons

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33
Q

5 medications that cause diarrhea

A 
Antibiotics 
Constipation medication 
Cancer medication 
SSRIs
Acetylcholine esterase inhibitors
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34
Q

7 medical conditions that cause diarrhea

A 
HIV
HYPERthyroidism
Short-gut
IBD irritable bowel syndrome
GI bleed
GI infection - C. Difficile
Malabsorption 
HIV
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35
Q

5 non pharmacological treatments for constipation

A 
D/c medication 
⬆️fluids
Fiber
Exercise 
Fecal impaction removal
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36
Q

2 diet cause of constipation

A

Malnutrition

Dehydration

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37
Q

4 non pharmacological treatments for diarrhea

A

D/c medication
Dietary Bulking fiber
Pads
Treat underlying cause

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38
Q

Explain how Parkinson’s can cause constipation

A

Parkinson’s result in decrease of dopamine. Dopamine initiates MOVEMENT ( GI motility); THEREFORE little dopamine equals little GI motility leading to constipation

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39
Q

How can cancer cause constipation

A

A tumor in intestine or rectum can block stool from moving through digestive tract leading to constipation

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40
Q

How can calcium channel blockers cause constipation

A

Calcium is responsible for contraction and in GI this means movement of GI tract. Calcium channel blockers have an effect on GUT smooth muscle by blocking action of calcium causing a relaxation of gut smooth muscle ⬇️ gut MOTILITY leading to constipation

41
Q

What does acetylcholine do?

A

Acetylcholine activates muscle movement. Acetylcholine bind to nicotinic ION channels receptors on Muscle cell membrane causing ion channels to open. Then there is an influx of Calcium into the muscle CELL initiating a sequence of steps that produce a muscle CONTRACTION.

42
Q

What is acetylcholine esterase?

A

Acetylcholine esterase is an enzyme that BREAKS DOWN acetylcholine

43
Q

What is PDE-5 and what is its function

A

Phosphodiesterase which degrades cGMP

44
Q

Explain pathway involving cGMP, PDE-5 and nitrous oxide

A

Nitrous oxide stimulate GC ( guanylate cyclase) to convert GTP➡️cGMP. cGMP causes a CALCIUM depletion ( spills out of muscle cell) RESULTING in smooth muscle relaxation LEADING to ⬆️ blood flow. PDE-5 breaks down cGMP. PDE-5 inhibitor stop action of PDE-5

45
Q

How do SSRIs cause diarrhea

A

Serotonin stimulate 5HT3 and 5HT4 receptors in GI tract which lead to ⬆️GI motility and GI cramps leading to diarrhea

Bonus info: serotonin cause nausea and vomiting by stimulating 5HT3 receptors in hypothalamus( in brain) and brain stem. ( CTZ)

46
Q

What is 1st line pharmacological treatment for PRN constipation .(3)

A

Fiber
Stool softeners
Osmotics

47
Q

What is the 2nd line pharmacological treatment for PRN constipation (3)

A

Stimulants
Suppositories
Enema

48
Q

What is 1st line pharmacological treatment for chronic constipation? (4)

A

Fiber
Stool softeners
Osmotics
Stimulants

49
Q

What is the 2nd line pharmacological treatment for CHRONIC constipation? ( 3)

A

Lubriprostone (Amitiza) in US ONLY
Linaclotide ( Linzess)
Prucalopride - drug in Canada

50
Q

MOA of Amitiza

A

Activates the chloride channel resulting in ⬆️fluid intestinal fluid secretion and intestinal motility

51
Q

How does Linzess work

A

It activates guanylate cyclase which stimulates conversion of GTP➡️cGMP which causes an ⬆️of intestinal fluid secretion thereby causing motility

52
Q

Name 2 major causes of Pressure Ulcers

A

Immobility

Poor tissue viability

53
Q

7 reasons for poor tissue viability

A 
Poor nutrition 
Urinary and fecal incontinence
Loss of muscle
Poor sensation 
Poor overall Mental( dementia)and Physical health
54
Q

3 non pharmacological treatment for Pressure ulcers

A
  • Repositioning / turning
  • promote good wound healing ( frequent change of pads, nutrition, dressing)
  • psychosocial support
55
Q

4 pharmacological treatment of Pressure ulcer

A
  • Nutritional treatment - protein supplement vitamin/nutrient supplement
    -Local treatment- wound cleansing with saline
    Debridement
    Topical treatment like a barrier cream
    Dressings ( hydrocolloid )
  • Biological treatment- platelet -derive growth factors ( becaplermin {regranex} only available in US
  • Other treatment: pain and infection control
56
Q

4 causes of sleep

A

Medications
Sleep apnea
Insomnia
Medical conditions

57
Q

4 medical conditions that cause sleep issues

A
  • Depression
  • Neurological conditions like Parkinsonism , Restless Leg syndrome, tremors
  • bladder issues like nocturia
  • HEART FAILURE
58
Q

3 non pharmacological treatments for sleep apnea

A
  • Weight loss
  • CPAP- continuous positive airway pressure
  • nasal surgery
59
Q

5 non pharmacological treatment of insomnia

A
  • sleep hygiene like Stimulus control and environmental changes ( white noise help patient get to sleep)
  • Avoid daytime naps
  • daytime activities- to avoid boredom which leads to sleep
  • relaxation techniques
  • “old remedies “
60
Q

What treatment do you avoid with sleep apnea

A

Avoid treating with SLEEP medications or STIMULANTS

61
Q

First line pharmacological treatment in insomnia and one issue with that treatment

A

Melatonin

Note: can cause instability with INR in warfarin patients

62
Q

2nd line pharmacological treatment in insomnia (2)

A
  • Mirtazapine ( Remeron)

- trazodone

63
Q

What 3 things mirtazapine is good to treat

A
  • sleep issues
  • mood issues
  • weight loss issues ( it helps you gain weight)
64
Q

Is a high dose or low dose effective in mirtazapine for insomnia and why?

A

LOW dose because it’s NOT as sedating with higher doses

65
Q

3rd line pharmacological treatment of insomnia

A

Benzodiazepines and non benzodiazepine ( only SHORT TERM)

66
Q

What 3 drug class to AVOID in insomnia and why?

A

Diphenhydramine
TCAs
Antipsychotics
Avoid agents with severe anticholinergic properties

67
Q

Name a cause of sleep apnea

A

Weight gain

68
Q

4 causes of dementia

A

Genetics
Reduced o2 to brain
Substance abuse
Medical conditions

69
Q

3 medical conditions that cause dementia

A

TBI - traumatic brain injury
HIV
Parkinson’s disease

70
Q

4 things that cause delirium

A

Substance intoxication
Substance withdrawal
Medications
Medical conditions

71
Q

11 medical conditions that cause delirium

A
  • Infections( ex UTI can alter state of mind)
  • Dementia - preexisting condition
  • Visual/hearing impairment ( sensory deficit can place patient at risk for delirium)
  • terminal illness
  • syphilis
  • pain
  • seizures- are neurological as well as STROKES
  • malnutrition
  • low B12/folate
  • electrolyte issues( low Na, BG)
  • urine/ stool retention
72
Q

2 forms of delirium

A

Hyperactive delirium-patient yelling, screaming trying to get out of bed ( agitated behavior)

Hypoactive delirium- most often UNDERdiagnosed

  • quiet patient
  • perfect patient
  • trouble staying awake( falling asleep while eating dinner)
73
Q

Define multifactorial

A

Multiple causes and multiple factors

74
Q

What assessment test is used to test for delirium

A

CAM ( confusion assessment test)

75
Q

4 things to check with CAM

A

Change in patient’s baseline mental status
Disorganized thinking
Altered level of consciousness
Inattentiveness

76
Q

Define delirium and is it an emergency

A

Neuropsychiatric syndrome and IT IS a medical emergency

77
Q

6 NON pharmacological treatments of DELIRIUM

A

1-Treat underlying condition ( ex UTI)
2-Reorient and redirect patient- day of week; who are you?; etc
3-Glasses on / hearing aid working
4-Sleep- healthy sleep habits
5-exercise- early mobility is a good PREVENTATIVE strategy
6-Taper or D/C unnecessary medication

78
Q

Although non pharmacological treatment is preferred for Delirium, what 2 pharmacological treatments could be used?

A

1-Antipsychotics like geodon ( ziprasidone) and haldol

2- last resort BZD to calm patient down ( smallest dose; shortest duration)

79
Q

6 types of dementia and explain each

A
  • Alzheimer’s
  • Vascular dementia- ⬇️blood supply to brain( ⬇️o2) like in stroke patients
  • Lewy body- named after person who discovered these tiny clumps of protein that develop inside brain and prevent cells form communicating properly by disrupting important chemical messengers between them eventually causing cells to DIE
  • Pseudodementia- looks like dementia but is depression
80
Q

Symptoms of Lewy body dementia

A

Hallucinations
Vivid dreams
Delusions- a false belief with no base in reality

81
Q

3 Medication to treat Alzheimer’s

A 
1-Acetylcholine esterase inhibitors 
Donepezil - Aricept
Rivastigmine- Exelon
Galantamine-Razadyne
2- NMDA ( n-methyl-d-aspartate)Antagonist
Memantine - Namenda
3-caprylidene (US only) a medical food
82
Q

Treatment of Vascular Dementia

A

Treat vascular issues

83
Q

Treatment of pseudodementia

A

SSRIs

84
Q

Treatment of Lewy Body Dementia

A

acetylcholine esterase inhibitors

85
Q

How to treat Alzheimer’s disease behavior

A

Avoid antipsychotics- use non pharmacological ways

86
Q

Lewy body Dementia can develop signs of what other disease

A

People with Lewy body can develop signs of Parkinson’s (usually muscle stiffness or rigidity- they don’t move fluidity)

87
Q

6 causes of vision issues with geriatric syndrome

A 
1- presbyopia 
2-cataracts 
3-glaucoma
4-macular degeneration
5-chronic dry eye
6- medications
88
Q

4 causes of hearing issues

A

1- wax
2- age related changes
3-inattention
4- medications

89
Q

Medication that can cause hearing issues

A

Aminogylcosides

90
Q

6 drugs that cause vision issues

A 
1-anticholinergics
2-eye drops ( resetting drops that are oil based ; glaucoma eye drops)
3-PDE-5 inhibitors 
4-tamsulOSIN
5- anticancer drugs
6-amiodarone
91
Q

Medications that cause what are the most common one to impact vision

A

That cause dry eyes

92
Q

7 NON pharmacological treatments of vision

A 
1- appropriate GLASSES
2- routine eye exams
3- control diabetes/ hypertension 
4-surgery
5- avoid ANTICHOLINERGICS
6-warm compress - helps with dry eyes
7-communication: large font, magnifiers, avoid glare,  contrasting colors
93
Q

3 communication treatment for vision

A
  • large font/ magnifier
  • avoid glare
  • contrasting color
94
Q

4 NON pharmacological treatments of hearing issues

A

1- remove ear wax
2- routine exams
3- hearing aid
4- communication

95
Q

3 communication non pharmacological treatments

A

1- enunciation
2-eliminate background noise
3-ask if needing to speak louder

96
Q

4 treatments of glaucoma

A

1- beta blockers - ex:timolol
2-prostaglandins-latanoprost- Xalatan ( a prostaglandin analog), travoprost- Travatan; bimatoprost- Lumigan
3-alpha 2 agonist- brimonidine- Alphagan
4-carbonic anhydrase inhibitors - dorzolamide- Trusopt; brinzolamide- Azopt

Cosopt( dorzolamide; timolol)

97
Q

3 treatments for Macular degeneration

A

These are anti-VEGF ( vascular endothelial growth factor inhibitors)
1- Avastin- bevaciZUMAB
2- Eylea- aflibercept
3- Lucentis- ranibiZUMAB

98
Q

3 treatments for Chronic dry eyes

A

1- OTC eye drops
2- cyclosporine- Restasis
3- D/C anticholinergics

99
Q

3 irrigation treatments for hearing done with what ingredients

A

Glycerin, hydrogen peroxide, mineral oil

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