Geriatrics

Question 1

What are the three most common infections that geriatric patients will present to hospital with?

Answer 1

Urinary tract infections
Pneumonia
Cellulitis

(In winter influenza becomes more common)

Question 2

What is the stat dose of gentamicin?

Answer 2

(4mg/kg)

Gentamicin useful in geriatric patients as an empirical antibiotic for UTIs.

Question 3

What is the antibiotic of choice for community acquired pneumonia?

Answer 3

Penicillin/Doxycycline or 3rd gen cephalosporin / Azithromycin

Question 4

What is the antibiotic of choice for nursing home cases of pneumonia?

Answer 4

Penicillin

Question 5

What is the antibiotic of choice for hospital acquired pneumonia?

Answer 5

Amoxycillin + clavulanate (mild)

Third gen cephalosporin (e.g. ceftriaxone, ceftazidime, cefotaxime) - (mod-severe)

Question 6

What is the antibiotic of choice for Aspiration Pneumoia?

Answer 6

Penicillin. These patients can look very sick due to pneumonitis.

Broaden cover if not responding. E.g. metronidazole, piperacillin + tazobactam.

Question 7

A patient presents with inflammation of the skin of both legs. What about this presentation makes it less likely to be dermatitis?

Answer 7

It is bilateral, which means it is more likely something like venous dermatitis as opposed to cellulitis.

Question 8

What is the treatment for cellulitis?

Answer 8

Flucloxacillin

Question 9

Your patient needs an IV to oral switch of their antibiotics as you cannot place a cannula. What are 4 good choices for broad spectrum oral antibiotics with high bioavailability?

Answer 9

Metronidazole
Fluconazole
Ciprofloxacin
Moxifloxacin

Question 10

What are the five I’s of the geriatric giants?

Answer 10

Iatrogenesis, immobility, instability, incontinence and impaired cognition

Question 11

Remember these drugs as they may cause confusion in the elderly.

C
S
A
A
A
D
L

Answer 11

Ciprofloxacin
Steroids
Antiparkinsonian drugs
Antiepileptics
Antipsychotics
Digoxin
Lithium

Question 12

Do calcium antagonists contribute to constipation. Yes or No?

Answer 12

Yes, they can contribute.

Question 13

Statins may have adverse reactions with what antibiotics to cause myopathy?

Answer 13

Macrolides
E.g. erythromycin, roxithromycin, azithromycin and clarithromycin

Temporarily suspend statins if macrolides are needed.

Question 14

Delirium accounts for what % of medical admissions?

Answer 14

10-20% in those 65+
More common (up to 50% in orthopaedics)

Delirium is also not benign. It has a mortality rate of 20-30%.

Question 15

Delirium may present as hyperactive and hypoactive subtypes. How do they differ?

Answer 15

Hyperactive
- Restless
- Hyperactive
-Alert
- Hallucinating

Hypoactive
- Apathetic
- Inert
- Drowsy
- Stuperose

Question 16

What are some precipitating factors of delirium?

D
E
L
I
R
I
U
M

Answer 16

Question 17

Haloperidol can be used to help sedate patients in certain specific circumstances.
What is the dosing for haloperidol?
How can it be administered?
What are the side effects?

What is an alternative to haloperidol?

Answer 17

It is doses in 0.5mg increments, at a minimum of 2 hour intervals to a max daily dose of 4-5mg.

D2 receptors are fully saturate at 4mg.

It can be administered PO, IM, IV

It has fewer anticholinergic side affects compared to many other options, little respiratory depression, and less significant sedation making it relatively well tolerated.
However, it can worsen confusion in the elderly, cause extrapyramidal symptoms, and impair swallowing.

Extrapyramidal symptoms: movement dysfunction such as dystonia (continuous spasms and muscle contractions), akathisia (may manifest as motor restlessness), parkinsonism characteristic symptoms such as rigidity, bradykinesia (slowness of movement), tremor, and tardive dyskinesia (irregular, jerky movements).

Alternative: Olanzapine
- Comes as a 5mg wafer making it easier for patients.
- Provide it in 2.5mg increments, 5-10 mg per 24hours

Alternative: Benzodiazepines
- Pretty much reserved for alcohol or benzo withdrawal.
- Do Not Use midaz on the wards to sedate patients.