Geriatrics

Question 1

Alzheimer’s dementia medical management

Answer 1

1) mild to moderate acetylcholinesterase inhibitors - donepezil, galantamine and rivastigmine)
2) second line or severe disease
memantine (an NMDA receptor antagonist)

Question 2

Contraindication to donepezil

Answer 2

Bradycardia

Question 3

Sedation in the elderly

Answer 3

1st line - 0.5mg haloperidol
Olanzapine

Avoid in Parkinson’s - give Quetiapine

Question 4

Drug class to avoid in dementia due to high risk mortality

Answer 4

Antipsychotics are associated with a significant increase in mortality in dementia patients

Question 5

Preferred analgesic in kidney disease

Answer 5

Oxycodone is preferred to morphine in palliative patients with mild-moderate renal impairment —> accumulation—>
opiate toxicity

The typical presentation can include reduced conscious level, slow respiratory rate, myoclonic jerks, and pinpoint pupils.

if renal impairment is more severe, alfentanil, buprenorphine and fentanyl are preferred

Question 6

Breakthrough analgesia

Answer 6

Breakthrough dose = 1/6th of daily morphine dose

Question 7

Lewy body vs Alzheimer’s

Answer 7

Visual hallucinations with dementia = Lewy body dementia

Alzheimer’s is mainly memory
Lewy body you also struggle with daily tasks and inattention

Lewy body diagnosed via single-photon emission computed tomography (SPECT)

Alzheimer’s via MRI

Lewy body can also be treated with anticholinesterase inhibitors

Question 8

Analgesia metastatic bone pain

Answer 8

Metastatic bone pain may respond to analgesia, bisphosphonates or radiotherapy

Question 9

What drugs are patients with Lewy body dementia very sensitive to and if given can cause deterioration

Answer 9

Neuroleptics eg. Haloperidol