Geriatrics Flashcards
What are the elements on the FRAIL scale for the identification of frailty?
Fatigue
Resistance (climb 1 flight of stairs)
Ambulation (able to walk 80m)
Illness >5
Loss of weight (5% in past year)
What do the numbers on the CFS mean? (4-9)
4: Pre-frail
5: some iADLs affected
6: some bADLs affected
7: fully dependent
8: end-of-life, fully dependent
9: Terminally ill but not too frail
What are the 3 interventions to make to help a frail patient?
- Exercise, OT/PT
- Nutrition, milk feeds if necessary (check barriers to nutrition)
- Medication review
What should be the main focus when treating a frail patient?
What matters most to the patient
What are the factors that determine that a fall is severe?
Injury
>= 2 falls in the past year
Frailty
Unable to get up / lying on the floor
Unconsciousness / possible syncope
What are the medication classes in the STOPPFall criteria?
Postural hypotension inducing: alpha-blockers, central antihypertensives, vasodilators, diuretics
Psychotropics: antidepressants, antipsychotics, benzodiazepines, z-drugs
Opioids
Anticholinergics
Anconvulsants
What should be assessed after a fall is determined to be not severe?
gait and balance
Why is orthostatic hypotension still an issue even if the patient does not experience symptoms?
Lack of perfusion to legs may result in leg weakness
What are the 4 categories of drugs that increase fall risk (as identified by prof)?
- Anti-cholinergics
- Sedatives
- Orthostatic hypotension
- hypoglycemic agents
How to identify delirium with 4AT?
Alertness
Abbreviated Test: DoB, age, year, place
Attention: dec-nov-… or 30-3-3…
Acuity
What are some drug classes that may cause delirium?
Benzos, Z-drugs, opioids, anti-cholinergics, H2RA
What are some prominent drug classes that may prolong delirium?
Anti-infectives (FQ, cefepime)
Steroids
H2RA
Opioids
Dopamine agonists
Anti-convulsants (levetiracetam)
Hypoglycemics
Which delirium pharmacotherapy should not be used in Parkinsonism? Outline dosing regimen
IV/IM/SC Haloperidol 0.3-1mg BD (max 5mg/day)
Which delirium pharmacotherapy is parkinson-friendly? outline dosing regimen
PO Quetiapine 6.25-12.5mg BD (max 100mg)
Which delirium pharmacotherapy is QTc friendly? outline dosing regimen
PO Olanzapine 1.25mg - 2.5mg (max 10mg/day)
What are the risk factors of delirium? (4)
- > =65 yo
- current hip fracture
- cognitive impairment / dementia
- severe illness (inc frailty)
What are the 5 classes of drugs that can help with dizziness?
- anti-cholinergics
- anti-dopamine
- calcium channel antagonist
- benzodiazepines
- betahistine
How long should the patient experience dizziness for for drugs to be useful?
30 mins
What are the types of dizziness?
- vertigo
- pre-syncopal (OH)
- disequilibrium
- unspecified
What anticholinergics can help with dizziness?
Prochlorperazine, dimenhydrinate, promethazine, scopolamine
What anti-dopaminergic agents can help with N/V associated with dizziness?
metoclopramide
alt: ondansetron (serotonin)
How does betahistine work and what are its contraindications?
H3 antagonist, partial H1 agonist, negligible H2 agonist
C/I in asthma, Hx of PUD
What benzodiazepines can help with dizziness?
clonazepam, lorazepam, diazepam
What calcium channel antagonists can help with dizziness?
cinnarizine
weight gain, sedation, antihistamine
Which classes of anti-dizziness medications cannot be used / used with caution in parkinsonism?
anti-dopamine, calcium channel antagonist
What is DIAPPERS for urinary incontinence?
Delirium
Infection
Atrophic vaginitis
Psychosis
Pharmacological
Excessive urine
Reduced mobility
Stool impactions
What receptors are activated in the filling phase of the bladder?
B3 adrenergic
alpha 1 adrenergic
What receptors are activated in the voiding phase of the bladder?
M3
How to manage stress incontinence?
Kegels
Topical estrogen
Duloxetine
How to manage urge incontinence?
Kegels
Topical estrogen
b3 agonist: mirabegron
M3 antagonist: solifenecin
How to manage overflow incontinence?
Outlet obstruction
- treat BPH / underlying structural issues
- bowel habit optimization
bladder underactivity
bethanechol, intermittent catheterisation
What are the general non-pharmacological strategies for the management of incontinence?
kegels
timed voiding
bladder retraining
continence products
weight loss, reduce irritants, water hygiene
How does phenytoin affect the bioavailability of dexamethasone?
induces CYP3A4, decrease bioavailability
How does clarithromycin interact with digoxin?
inhibit p-gp, increase conc. of digoxin, increase toxicity
What drugs are affected by a decrease in gastric acid?
- vit B, Ca, Fe
- Azoles
- keto decrease
- itra (capsule) increase or decrease
- vori, pos may be affected too - Cancer -tinibs: dasatinib, erlotinib
What drugs result in reduced gastric emptying?
opioids, anticholinergics
When must albumin be taken into account when interpreting phenytoin dose?
albumin < 40
What happens to the blood brain barrier in the elderly?
becomes more leaky, p-gp become more forgiving
How does frailty affect metabolism?
decreases metabolism cuz inflammation
What are the common inhibitors of liver enzymes?
Azoles, clarithromycin, cimetidine
What are the common inducers of liver enzymes?
phenytoin, CBZ, rifampins
Why does phase I metabolism decrease in older age?
decreased liver mass, reduced liver blood flow, thickening of sinusoidal epithelium
When should dialysis patients not be given NSAIDs?
when there is residual kidney function
When is a patient at risk of AKI?
dehydrated + diuretics, NSAIDs, coxibs, ACEi
Which drugs should not be used in patients with DLB / PDD / parkinsonism due to increasing risk of neuroleptic sensitivity reaction?
Metoclopramide, prochlorperazine, promethazine, antipsychotics (except low dose quetiapine)
Why are patients with dementia more sensitive to anticholinergic agents?
decrease ACh reserves
