GERIATRICS

Question 1

What investigations should you order after a falls assessment?

Answer 1

ECG
Urine dip
BM
Bloods

Question 2

What is the definition of polypharmacy?

Answer 2

> 4 drugs

Question 3

Why is polypharmacy a problem?

Answer 3

Age is a risk factor for many chronic conditions that need to be treated pharmacologically.
Increase chance of drug interactions.

Question 4

Name some physiological changes associated with ageing.

Answer 4

Relative increase in adipose tissue (less body water/lean muscle)
Decline in renal function

Question 5

How does ageing affect pharmacokinetics (how the body interacts with a drug)?

Answer 5

Distribution:

• Body fat increase - increased volume of fat soluble drugs
• Water decrease - increased volume of water soluble drugs
• Albumin decrease - increases effects of albumin-bound drugs

Metabolism:
- Decreased

Excretion:
-GFR reduced

Question 6

Which drugs are affected by changes in distribution?

Answer 6

Increased fat: ^diazepam

Decreased water: ^digoxin, ^paracetamol, ^alcohol

Question 7

Which drugs can cause postural hypotension?

Answer 7

Alpha-blockers
Anti-hypertensives
Anti-depressants
Beta-blockers
Diuretics
Hypnotics
Nitrates

Question 8

How should diuretics be reviewed in the elderly?

Answer 8

Diuretics are overprescribed in old age and should not be used on a long-term basis.
Simple gravitational oedema should be managed with increased movement, raising the legs, and support stockings

Question 9

Which drugs should be dose-adjusted in the elderly?

Answer 9

Digoxin
Paracetamol
Opioids

Question 10

What is seen on CT in Alzheimer’s?

Answer 10

Widespread cerebral atrophy

Question 11

What blood tests should be ordered in suspected dementia?

Answer 11

A blood screen including FBC, U&E, LFTs, calcium, glucose, ESR/CRP, TFTs, vitamin B12 and folate levels should be done in patients with suspected dementia to check for reversible causes

Question 12

Which medications should be stopped in patients with dementia?

Answer 12

Tricyclic antidepressants

Question 13

What is the first-line treatment for mild-moderate dementia?

Answer 13

acetylcholinesterase inhibitors

Donepezil
Galantamine
Rivastigmine

Question 14

What is second-line pharmacological treatment for moderate dementia?

Answer 14

Acetylcholinesterase inhibitor + memantine (NMDA receptor antagonist)

Question 15

Give some non-pharmacological approaches to managing dementia

Answer 15

NICE recommend offering ‘a range of activities to promote wellbeing that are tailored to the person’s preference’

NICE recommend offering group cognitive stimulation therapy for patients with mild and moderate dementia

other options to consider include group reminiscence therapy and cognitive rehabilitation

Question 16

What is 1st line medication for severe dementia?

Answer 16

Memantine

Question 17

Give a contraindication to donepezil

Answer 17

Bradycardia

Question 18

Give a side effect of donepezil

Answer 18

Insomnia

Question 19

Which score is used to identify the risk of pressure sores?

Answer 19

Waterlow score

Question 20

Which factors predispose patients to developing pressure ulcers?

Answer 20

malnourishment
incontinence
lack of mobility
pain (leads to a reduction in mobility)

Question 21

What is the grading system used for pressure ulcers?

Answer 21

Grade 1 = discolouration, warmth, oedema

Grade 2 = Partial thickness skin loss

Grade 3 = Full thickness skin loss

Grade 4 = tissue necrosis, damage of bone

Question 22

What dressings should be applied to pressure ulcers?

Answer 22

Hydrocolloid dressings/gels

Question 23

How do you decide to use antibiotics for a pressure ulcer?

Answer 23

Clinical - wound swabs are not routinely done as most are colonised

Question 24

What is the STOPP tool used for?

Answer 24

identifies medications where the risk outweighs the therapeutic benefits in certain conditions

Question 25

Which medications are associated with a significant increase in mortality in dementia patients?

Answer 25

Anti-psychotics