GERIATRICS Flashcards
What investigations should you order after a falls assessment?
ECG
Urine dip
BM
Bloods
What is the definition of polypharmacy?
> 4 drugs
Why is polypharmacy a problem?
Age is a risk factor for many chronic conditions that need to be treated pharmacologically.
Increase chance of drug interactions.
Name some physiological changes associated with ageing.
Relative increase in adipose tissue (less body water/lean muscle)
Decline in renal function
How does ageing affect pharmacokinetics (how the body interacts with a drug)?
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
Which drugs are affected by changes in distribution?
Increased fat: ^diazepam
Decreased water: ^digoxin, ^paracetamol, ^alcohol
Which drugs can cause postural hypotension?
Alpha-blockers Anti-hypertensives Anti-depressants Beta-blockers Diuretics Hypnotics Nitrates
How should diuretics be reviewed in the elderly?
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
Which drugs should be dose-adjusted in the elderly?
Digoxin
Paracetamol
Opioids
What is seen on CT in Alzheimer’s?
Widespread cerebral atrophy
What blood tests should be ordered in suspected dementia?
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
Which medications should be stopped in patients with dementia?
Tricyclic antidepressants
What is the first-line treatment for mild-moderate dementia?
acetylcholinesterase inhibitors
Donepezil
Galantamine
Rivastigmine
What is second-line pharmacological treatment for moderate dementia?
Acetylcholinesterase inhibitor + memantine (NMDA receptor antagonist)
Give some non-pharmacological approaches to managing dementia
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
What is 1st line medication for severe dementia?
Memantine
Give a contraindication to donepezil
Bradycardia
Give a side effect of donepezil
Insomnia
Which score is used to identify the risk of pressure sores?
Waterlow score
Which factors predispose patients to developing pressure ulcers?
malnourishment
incontinence
lack of mobility
pain (leads to a reduction in mobility)
What is the grading system used for pressure ulcers?
Grade 1 = discolouration, warmth, oedema
Grade 2 = Partial thickness skin loss
Grade 3 = Full thickness skin loss
Grade 4 = tissue necrosis, damage of bone
What dressings should be applied to pressure ulcers?
Hydrocolloid dressings/gels
How do you decide to use antibiotics for a pressure ulcer?
Clinical - wound swabs are not routinely done as most are colonised
What is the STOPP tool used for?
identifies medications where the risk outweighs the therapeutic benefits in certain conditions
Which medications are associated with a significant increase in mortality in dementia patients?
Anti-psychotics
