Geriatric Syndromes Flashcards
1
Q
Syndrome
A
A group of signs and symptoms that occur together
2
Q
4 domains in Geriatric syndrome
A
1- cognitive function
2-motor function
3- sensory function
4-psychosocial function
3
Q
5 areas of motor functions
A
Muscle strength Reflexes Coordination Voluntary control of body functions Gait/ balance
4
Q
5 psychosocial functions
A
Appetite Sleep/wake Personality Behavior Mood/Ideation
5
Q
5 sensory functions
A
Vision Smell Hearing Taste Touch
6
Q
5 cognitive functions
A
Memory Insight/ interpretation Orientation/ level of consciousness Attention/ concentration Problem solving/ decision making
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
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
9
Q
Incontinence
A
Involuntary loss of urine or bowel
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
11
Q
First line of therapy for incontinence involving bladder
A
Do not use medication
12
Q
Name 5 non pharm treatment to stress incont
A
Weight loss Kegel exercise Pads Pessaries Surgery
13
Q
Name 4 non pharmacological tx for Urge incontinence
A
Weight loss
Kegel
Pads
Fluid reduction
14
Q
4 non pharmacological tax of overflow incontinence
A
Pads
Fluid reduction
TED hose
Catheter
15
Q
Non Pharmacological tx for Mixed incontinence
A
Treat predominant type
16
Q
4 non pharmacological tx for functional incontinence
A
Schedule voiding
Prompted voiding( reminding patient)
Commode
Grab bars
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
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
19
Q
What effect does acetylcholine have on bladder
A
Increases urination
20
Q
Name 5 anticholinergics( antimuscarinics )drugs use to treat URGE incontinence
A
Detrol- tolTERODENE Toviaz- fesoTERODINE Sanctura -trospium Vesicare- soliFENACIN Enablex-dariFENACIN
21
Q
Another name for urge incontinence
A
Overactive bladder
22
Q
Name 1 beta 3 agonist to treat URGE
A
Myrbetriq- mirabegron it doesn’t go through anticholinergic pathway
23
Q
3 drug classes to treat overflow incontinence( BPH)
A
Alpha blockers
5 alpha reductive inhibitors
PDE-5 inhibitors
24
Q
MOA of alpha-1 blockers
A
They limit prostate enlargement ( in BPH the prostate enlarge and cause a blockage of urethra
25
Name alpha-1 blockers to treat BPH
```
alfuZOSIN- Uroxatral- selective
doxaZOSIN-Cardura
teraZOSIN-Hytrin
tamsulOSIN- Flomax- selective and 1st line treatment
silodOSIN-rapaflo- selective
```
26
Difference between selective and non selective alpha blockers
Selective alpha-1 blockers are better because they prevent dizziness caused by non selective
27
Name (2) 5 alpha reductase inhibitors to treat overflow incontinence
dutASTERIDE-Avodart
| finASTERIDE-Proscar
28
What is PDE-5 inhibitor,it's MOA, and which one has been approved for both BPH and sexual erectile dysfunction.
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
29
Medication for Mixed urinary incontinence
Treat predominant cause
30
MOA of antimuscarinics in urge incontinence
⬇️detruser muscle contraction
31
Name 4 meds that can cause constipation
Opioids
Calcium channel blockers
AntiCHOLINERGICS
iron supplements
32
3 medical conditions that can cause constipation
Cancer
HYPOthyroidism
Neurological disorders like Parkinsons
33
5 medications that cause diarrhea
```
Antibiotics
Constipation medication
Cancer medication
SSRIs
Acetylcholine esterase inhibitors
```
34
7 medical conditions that cause diarrhea
```
HIV
HYPERthyroidism
Short-gut
IBD irritable bowel syndrome
GI bleed
GI infection - C. Difficile
Malabsorption
HIV
```
35
5 non pharmacological treatments for constipation
```
D/c medication
⬆️fluids
Fiber
Exercise
Fecal impaction removal
```
36
2 diet cause of constipation
Malnutrition
| Dehydration
37
4 non pharmacological treatments for diarrhea
D/c medication
Dietary Bulking fiber
Pads
Treat underlying cause
38
Explain how Parkinson's can cause constipation
Parkinson's result in decrease of dopamine. Dopamine initiates MOVEMENT ( GI motility); THEREFORE little dopamine equals little GI motility leading to constipation
39
How can cancer cause constipation
A tumor in intestine or rectum can block stool from moving through digestive tract leading to constipation
40
How can calcium channel blockers cause constipation
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
What does acetylcholine do?
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
What is acetylcholine esterase?
Acetylcholine esterase is an enzyme that BREAKS DOWN acetylcholine
43
What is PDE-5 and what is its function
Phosphodiesterase which degrades cGMP
44
Explain pathway involving cGMP, PDE-5 and nitrous oxide
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
How do SSRIs cause diarrhea
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
What is 1st line pharmacological treatment for PRN constipation .(3)
Fiber
Stool softeners
Osmotics
47
What is the 2nd line pharmacological treatment for PRN constipation (3)
Stimulants
Suppositories
Enema
48
What is 1st line pharmacological treatment for chronic constipation? (4)
Fiber
Stool softeners
Osmotics
Stimulants
49
What is the 2nd line pharmacological treatment for CHRONIC constipation? ( 3)
Lubriprostone (Amitiza) in US ONLY
Linaclotide ( Linzess)
Prucalopride - drug in Canada
50
MOA of Amitiza
Activates the chloride channel resulting in ⬆️fluid intestinal fluid secretion and intestinal motility
51
How does Linzess work
It activates guanylate cyclase which stimulates conversion of GTP➡️cGMP which causes an ⬆️of intestinal fluid secretion thereby causing motility
52
Name 2 major causes of Pressure Ulcers
Immobility
| Poor tissue viability
53
7 reasons for poor tissue viability
```
Poor nutrition
Urinary and fecal incontinence
Loss of muscle
Poor sensation
Poor overall Mental( dementia)and Physical health
```
54
3 non pharmacological treatment for Pressure ulcers
- Repositioning / turning
- promote good wound healing ( frequent change of pads, nutrition, dressing)
- psychosocial support
55
4 pharmacological treatment of Pressure ulcer
- 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
4 causes of sleep
Medications
Sleep apnea
Insomnia
Medical conditions
57
4 medical conditions that cause sleep issues
- Depression
- Neurological conditions like Parkinsonism , Restless Leg syndrome, tremors
- bladder issues like nocturia
- HEART FAILURE
58
3 non pharmacological treatments for sleep apnea
- Weight loss
- CPAP- continuous positive airway pressure
- nasal surgery
59
5 non pharmacological treatment of insomnia
- 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
What treatment do you avoid with sleep apnea
Avoid treating with SLEEP medications or STIMULANTS
61
First line pharmacological treatment in insomnia and one issue with that treatment
Melatonin
| Note: can cause instability with INR in warfarin patients
62
2nd line pharmacological treatment in insomnia (2)
- Mirtazapine ( Remeron)
| - trazodone
63
What 3 things mirtazapine is good to treat
- sleep issues
- mood issues
- weight loss issues ( it helps you gain weight)
64
Is a high dose or low dose effective in mirtazapine for insomnia and why?
LOW dose because it's NOT as sedating with higher doses
65
3rd line pharmacological treatment of insomnia
Benzodiazepines and non benzodiazepine ( only SHORT TERM)
66
What 3 drug class to AVOID in insomnia and why?
Diphenhydramine
TCAs
Antipsychotics
Avoid agents with severe anticholinergic properties
67
Name a cause of sleep apnea
Weight gain
68
4 causes of dementia
Genetics
Reduced o2 to brain
Substance abuse
Medical conditions
69
3 medical conditions that cause dementia
TBI - traumatic brain injury
HIV
Parkinson's disease
70
4 things that cause delirium
Substance intoxication
Substance withdrawal
Medications
Medical conditions
71
11 medical conditions that cause delirium
- 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
2 forms of delirium
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
Define multifactorial
Multiple causes and multiple factors
74
What assessment test is used to test for delirium
CAM ( confusion assessment test)
75
4 things to check with CAM
Change in patient's baseline mental status
Disorganized thinking
Altered level of consciousness
Inattentiveness
76
Define delirium and is it an emergency
Neuropsychiatric syndrome and IT IS a medical emergency
77
6 NON pharmacological treatments of DELIRIUM
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
Although non pharmacological treatment is preferred for Delirium, what 2 pharmacological treatments could be used?
1-Antipsychotics like geodon ( ziprasidone) and haldol
| 2- last resort BZD to calm patient down ( smallest dose; shortest duration)
79
6 types of dementia and explain each
- 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
Symptoms of Lewy body dementia
Hallucinations
Vivid dreams
Delusions- a false belief with no base in reality
81
3 Medication to treat Alzheimer's
```
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
Treatment of Vascular Dementia
Treat vascular issues
83
Treatment of pseudodementia
SSRIs
84
Treatment of Lewy Body Dementia
acetylcholine esterase inhibitors
85
How to treat Alzheimer's disease behavior
Avoid antipsychotics- use non pharmacological ways
86
Lewy body Dementia can develop signs of what other disease
People with Lewy body can develop signs of Parkinson's (usually muscle stiffness or rigidity- they don't move fluidity)
87
6 causes of vision issues with geriatric syndrome
```
1- presbyopia
2-cataracts
3-glaucoma
4-macular degeneration
5-chronic dry eye
6- medications
```
88
4 causes of hearing issues
1- wax
2- age related changes
3-inattention
4- medications
89
Medication that can cause hearing issues
Aminogylcosides
90
6 drugs that cause vision issues
```
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
Medications that cause what are the most common one to impact vision
That cause dry eyes
92
7 NON pharmacological treatments of vision
```
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
3 communication treatment for vision
- large font/ magnifier
- avoid glare
- contrasting color
94
4 NON pharmacological treatments of hearing issues
1- remove ear wax
2- routine exams
3- hearing aid
4- communication
95
3 communication non pharmacological treatments
1- enunciation
2-eliminate background noise
3-ask if needing to speak louder
96
4 treatments of glaucoma
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
3 treatments for Macular degeneration
These are anti-VEGF ( vascular endothelial growth factor inhibitors)
1- Avastin- bevaciZUMAB
2- Eylea- aflibercept
3- Lucentis- ranibiZUMAB
98
3 treatments for Chronic dry eyes
1- OTC eye drops
2- cyclosporine- Restasis
3- D/C anticholinergics
99
3 irrigation treatments for hearing done with what ingredients
Glycerin, hydrogen peroxide, mineral oil
