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
