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3rd yr clinical > Geriatrics > Flashcards

Geriatrics Flashcards

1
Q

What is the first line sedative used in delirium

A

Treat underlying cause first and use de-escalating measures

Haloperidol 0.5mg

If they have Parkinson’s may need to reduce Parkinson’s meds slightly as antipsychotics can worsen parkinsonian symptoms

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2
Q

What are the different treatment options for Alzheimer’s disease?

A

Group cognitive stimulation and activities

Medications
1st line -Acetylcholinesterase inhibitors
Donepezil, galantamine and rivastigmine

2nd line - Memantine (NMDA receptor antagonist)
can also be an add on to 1st line if severe Alzheimer’s

Donepezil is contraindicated with bradycardia
Can also cause insomnia

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3
Q

What pathological changes are seen in Alzheimer’s

A

Widespread cerebral atrophy (cortex and hippocampus)
Beta-amyloid protein and intraneuronal neurofibrillary tangles
Tau protein

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4
Q

What is the management of dementia in primary and secondary care?

A

Primary care- blood screens exclude other causes (hypothyroid)- U&e, LFTs, Glucose, ESR/CRP, TFTs, B12 and folate

Secondary care- neuroimaging and memory clinic

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5
Q

What medications can cause postural hypotension

A

Nitrates
Diuretics
Anti-cholinergics
Antidepressants
B-blockers
L-dopa
ACE inhibit

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6
Q

What are the features of frontotemporal lobar dementia

A

Onset before 65
Insidious onset
Preserved memory and visuospatial skills
Personality change and social conduct problems

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7
Q

What are the features of Pick’s disease

A

Most common type of frontotemporal dementia
Personality change and social impairment

Increased appetite, disinhibition

Will show focal gyro atrophy with a knife blade appearance

Pick’s bodies present

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8
Q

What is semantic dementia

A

Fluent progressive aphasia
Fluent speech but makes no sense
Better memory for recent events instead of past

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9
Q

What are the features of Lewy Body dementia

A

Progressive cognitive impairment- happens before Parkinson’s- if it happens after then this is Parkinson’s with dementia

Flutuating cognition
Impaired attention and function rather than just memory loss
Parkinsonism
Visual hallucinations

Can give
Acetylcholinesterase inhibit and memantine

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10
Q

When should patients take a bisphosphate holiday

A

After 3 years

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11
Q

What are the predisposing factors to pressure ulcers

A

Malnourishment
Incontinence
Immobility
Pain

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12
Q

What scoring system is used to screen for pressure ulcer risk

A

Waterlow score

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13
Q

How are pressure ulcers graded

A

Grade 1 - non blanch erythema of skin - skin intact

Grade 2- Partial thickness of skin lost- epidermis and dermis or both- superficial- abrasion or blister

Grade 3- Full thickness - damage or necrosis of subcutwon’t go through the fascia

Grade 4- extensive necrosis with damage to muscle/ bone

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14
Q

What is the management of a pressure ulcer

A

Moist wound environment for healing - hydrocolloid dressings and gels

Only give abx if features of cellulitis

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15
Q

What are the features of vascular dementia

A

Risk factors
History of stroke, AF, HTN, DM, hyperlipidaemia, smoking, obesity, CHD, fam history

Presentation
Several months/ years of sudden or stepwise deterioration of cognitive function

Symptoms
Focal neuro issues- visual, sensory or motor symptoms
Seizures
Attention and concentration issues
Gait disturbance
Speech and emotion disturbance

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16
Q

What is the management of agitation and confusion in palliative care

A

Treat any underlying conditions
First choice- Haloperidol
Other options- chlorpromazine, levopromazine (antipsychotics)

If in terminal phase of illness give midazolam

17
Q

What is the management of hiccups in palliative care

A

Chlorpromazine
Second line haloperidol and gabapentin

Dexamethasone if there are hepatic lesions

18
Q

What are the 6 nausea and vomiting syndromes in palliative care

A
  1. Reduced gastric motility- opioids
  2. Chemically mediated- hypercalcaemia, opioids, chemo
  3. Visceral/ serosal- constipation/ candidiasis
  4. Raised ICP- cerebral mets
  5. Vestibular- acetylcholine and H1 receptors, opiod related, motion related or base of skull tumours
  6. Cortical- Anxiety, pain, fear/ anticipatory nausea
19
Q

How is Nausea and vomiting treated when related to reduced gastric motility

A

Metoclopramide and domperidone

In complete bowel obstruction, GI perf or after gastric surgery do not use pro-kinesis drugs like metoclopramide

20
Q

How is nausea and vomiting treated in the context of an opiod related chemical disturbance

A

Treat chemical imbalance
Ondanstrol, haloperiodol, levopromazine

21
Q

How is nausea and vomiting treated in the context of visceral and serosal issues

A

Cyclizine and levomepromazine

22
Q

How is nausea and vomiting treated in the context of raised ICP

A

Cyclizine
Dexamethasone
Radiotherapy

23
Q

How is nausea and vomiting treated in the context of vestibular issues

A

Cyclizine
If refractory- metoclopramide or prochlorperazine

24
Q

How is nausea and vomiting treated in the context of cortical issues

A

Anticipatory- short acting benzo- loraz
Cyclizine

25
Q

What is the starting treatment for pain in palliative care

A

Regular oral modified release or oral immediate release opiod (patient preference) along with immediate release morphine for break through pain

Start with 20-30mg (split into 2 doses usually) MR per day with 5mg morphine for breakthrough pain

Oral modified release in preference to transdermal

Laxatives prescribed

26
Q

What is the conversion of oral codeine to oral morphine

What is the conversion or oral tramadol to oral morphine

A

Divide codeine dose by 10 to get morphine dose

Divide tramadol dose by 10

27
Q

What is the conversion of oral morphine to oral oxycodone

A

Divide oral morphine by 1.5-2 to get oral oxycodone

28
Q

What are the conversions for transdermal patches

A

Transdermal fentanyl 12 microgram patch = 30 mg oral morphine

Transdermal buprenorphine 10 microgram patch= 24 oral morphine

29
Q

How do you convert oral morphine to sub cut morphine

A

Divide by 2

30
Q

How do you convert oral morphine to subcut diamorphine

A

Divide by 3

31
Q

How do you convert oral oxycodone to subcut diamorphine

A

Divide by 1.5

32
Q

What is the management of secretions in palliative care

A

Hycosine hydrobromide or hycosine butylbromide- doesnt matter which

Hycosine butyl bromide is less sedated

Hycosine hydrobromide- given subcut or infusion

33
Q

How to calculate breakthrough dosage

A

1/6th of daily morphine dose

34
Q

How is chemo side effects nausea and vomiting managed

A

Low risk- metoclopramide
High risk add a 5HT3 antagonist like ondansetron can combine with dex

35
Q

What are the preferred opioids in impaired renal function

A

Alfentanil
Buprenorphine
Fentanyl

Oxycodone if renal impairment is mild to moderate

3rd yr clinical (22 decks)

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