Geriatric Syndromes Flashcards
Syndrome
A group of signs and symptoms that occur together
4 domains in Geriatric syndrome
1- cognitive function
2-motor function
3- sensory function
4-psychosocial function
5 areas of motor functions
Muscle strength Reflexes Coordination Voluntary control of body functions Gait/ balance
5 psychosocial functions
Appetite Sleep/wake Personality Behavior Mood/Ideation
5 sensory functions
Vision Smell Hearing Taste Touch
5 cognitive functions
Memory Insight/ interpretation Orientation/ level of consciousness Attention/ concentration Problem solving/ decision making
Define geriatric syndrome
Clinical
Multifactorial health conditions that DO NOT FIT into specific disease categories, impact Multiple domains and are associated with Morbidity and Mortality
Name 8 things that cause BLADDER Issues
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
Incontinence
Involuntary loss of urine or bowel
5 precipitating causes of incontinence
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
First line of therapy for incontinence involving bladder
Do not use medication
Name 5 non pharm treatment to stress incont
Weight loss Kegel exercise Pads Pessaries Surgery
Name 4 non pharmacological tx for Urge incontinence
Weight loss
Kegel
Pads
Fluid reduction
4 non pharmacological tax of overflow incontinence
Pads
Fluid reduction
TED hose
Catheter
Non Pharmacological tx for Mixed incontinence
Treat predominant type
4 non pharmacological tx for functional incontinence
Schedule voiding
Prompted voiding( reminding patient)
Commode
Grab bars
2 Drugs that treat bladder incontinence ( stress)
SNRI - duloxetine ; (approve in Europe not in US;MOA -⬆️norepinephrine can reduce stress incontinence)
Alpha agonist like sudafed but not recommended
3 Drugs that treat bladder incontinence ( urge)
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
What effect does acetylcholine have on bladder
Increases urination
Name 5 anticholinergics( antimuscarinics )drugs use to treat URGE incontinence
Detrol- tolTERODENE Toviaz- fesoTERODINE Sanctura -trospium Vesicare- soliFENACIN Enablex-dariFENACIN
Another name for urge incontinence
Overactive bladder
Name 1 beta 3 agonist to treat URGE
Myrbetriq- mirabegron it doesn’t go through anticholinergic pathway
3 drug classes to treat overflow incontinence( BPH)
Alpha blockers
5 alpha reductive inhibitors
PDE-5 inhibitors
MOA of alpha-1 blockers
They limit prostate enlargement ( in BPH the prostate enlarge and cause a blockage of urethra
Name alpha-1 blockers to treat BPH
alfuZOSIN- Uroxatral- selective doxaZOSIN-Cardura teraZOSIN-Hytrin tamsulOSIN- Flomax- selective and 1st line treatment silodOSIN-rapaflo- selective
Difference between selective and non selective alpha blockers
Selective alpha-1 blockers are better because they prevent dizziness caused by non selective
Name (2) 5 alpha reductase inhibitors to treat overflow incontinence
dutASTERIDE-Avodart
finASTERIDE-Proscar
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
Medication for Mixed urinary incontinence
Treat predominant cause
MOA of antimuscarinics in urge incontinence
⬇️detruser muscle contraction
Name 4 meds that can cause constipation
Opioids
Calcium channel blockers
AntiCHOLINERGICS
iron supplements
3 medical conditions that can cause constipation
Cancer
HYPOthyroidism
Neurological disorders like Parkinsons
5 medications that cause diarrhea
Antibiotics Constipation medication Cancer medication SSRIs Acetylcholine esterase inhibitors
7 medical conditions that cause diarrhea
HIV HYPERthyroidism Short-gut IBD irritable bowel syndrome GI bleed GI infection - C. Difficile Malabsorption HIV
5 non pharmacological treatments for constipation
D/c medication ⬆️fluids Fiber Exercise Fecal impaction removal
2 diet cause of constipation
Malnutrition
Dehydration
4 non pharmacological treatments for diarrhea
D/c medication
Dietary Bulking fiber
Pads
Treat underlying cause
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
How can cancer cause constipation
A tumor in intestine or rectum can block stool from moving through digestive tract leading to constipation
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
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.
What is acetylcholine esterase?
Acetylcholine esterase is an enzyme that BREAKS DOWN acetylcholine
What is PDE-5 and what is its function
Phosphodiesterase which degrades cGMP
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
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)
What is 1st line pharmacological treatment for PRN constipation .(3)
Fiber
Stool softeners
Osmotics
What is the 2nd line pharmacological treatment for PRN constipation (3)
Stimulants
Suppositories
Enema
What is 1st line pharmacological treatment for chronic constipation? (4)
Fiber
Stool softeners
Osmotics
Stimulants
What is the 2nd line pharmacological treatment for CHRONIC constipation? ( 3)
Lubriprostone (Amitiza) in US ONLY
Linaclotide ( Linzess)
Prucalopride - drug in Canada
MOA of Amitiza
Activates the chloride channel resulting in ⬆️fluid intestinal fluid secretion and intestinal motility
How does Linzess work
It activates guanylate cyclase which stimulates conversion of GTP➡️cGMP which causes an ⬆️of intestinal fluid secretion thereby causing motility
Name 2 major causes of Pressure Ulcers
Immobility
Poor tissue viability
7 reasons for poor tissue viability
Poor nutrition Urinary and fecal incontinence Loss of muscle Poor sensation Poor overall Mental( dementia)and Physical health
3 non pharmacological treatment for Pressure ulcers
- Repositioning / turning
- promote good wound healing ( frequent change of pads, nutrition, dressing)
- psychosocial support
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
4 causes of sleep
Medications
Sleep apnea
Insomnia
Medical conditions
4 medical conditions that cause sleep issues
- Depression
- Neurological conditions like Parkinsonism , Restless Leg syndrome, tremors
- bladder issues like nocturia
- HEART FAILURE
3 non pharmacological treatments for sleep apnea
- Weight loss
- CPAP- continuous positive airway pressure
- nasal surgery
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 “
What treatment do you avoid with sleep apnea
Avoid treating with SLEEP medications or STIMULANTS
First line pharmacological treatment in insomnia and one issue with that treatment
Melatonin
Note: can cause instability with INR in warfarin patients
2nd line pharmacological treatment in insomnia (2)
- Mirtazapine ( Remeron)
- trazodone
What 3 things mirtazapine is good to treat
- sleep issues
- mood issues
- weight loss issues ( it helps you gain weight)
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
3rd line pharmacological treatment of insomnia
Benzodiazepines and non benzodiazepine ( only SHORT TERM)
What 3 drug class to AVOID in insomnia and why?
Diphenhydramine
TCAs
Antipsychotics
Avoid agents with severe anticholinergic properties
Name a cause of sleep apnea
Weight gain
4 causes of dementia
Genetics
Reduced o2 to brain
Substance abuse
Medical conditions
3 medical conditions that cause dementia
TBI - traumatic brain injury
HIV
Parkinson’s disease
4 things that cause delirium
Substance intoxication
Substance withdrawal
Medications
Medical conditions
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
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)
Define multifactorial
Multiple causes and multiple factors
What assessment test is used to test for delirium
CAM ( confusion assessment test)
4 things to check with CAM
Change in patient’s baseline mental status
Disorganized thinking
Altered level of consciousness
Inattentiveness
Define delirium and is it an emergency
Neuropsychiatric syndrome and IT IS a medical emergency
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
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)
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
Symptoms of Lewy body dementia
Hallucinations
Vivid dreams
Delusions- a false belief with no base in reality
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
Treatment of Vascular Dementia
Treat vascular issues
Treatment of pseudodementia
SSRIs
Treatment of Lewy Body Dementia
acetylcholine esterase inhibitors
How to treat Alzheimer’s disease behavior
Avoid antipsychotics- use non pharmacological ways
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)
6 causes of vision issues with geriatric syndrome
1- presbyopia 2-cataracts 3-glaucoma 4-macular degeneration 5-chronic dry eye 6- medications
4 causes of hearing issues
1- wax
2- age related changes
3-inattention
4- medications
Medication that can cause hearing issues
Aminogylcosides
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
Medications that cause what are the most common one to impact vision
That cause dry eyes
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
3 communication treatment for vision
- large font/ magnifier
- avoid glare
- contrasting color
4 NON pharmacological treatments of hearing issues
1- remove ear wax
2- routine exams
3- hearing aid
4- communication
3 communication non pharmacological treatments
1- enunciation
2-eliminate background noise
3-ask if needing to speak louder
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)
3 treatments for Macular degeneration
These are anti-VEGF ( vascular endothelial growth factor inhibitors)
1- Avastin- bevaciZUMAB
2- Eylea- aflibercept
3- Lucentis- ranibiZUMAB
3 treatments for Chronic dry eyes
1- OTC eye drops
2- cyclosporine- Restasis
3- D/C anticholinergics
3 irrigation treatments for hearing done with what ingredients
Glycerin, hydrogen peroxide, mineral oil
