Geriatrics

Question 1

Vaccinations indicated for elderly

Answer 1

Tetanus booster every 10 years
Pneumococcal (once after 65)
Influenza (yearly)
Herpes zoster (once after 60)

Question 2

How are pharmacokinetics altered in the elderly?

Answer 2

• decline in gastric acid; altered absorption- interstitial and skin perfusion declines; slower absorption of topicals or IM injections
• reduced free water and serum proteins (higher active drug concentrations)
• decline in liver metabolism and renal clearance

Question 3

Define delirium

Answer 3

alteration of consciousness, waxing & waning symptoms, psychomotor retardation or agitation, and decreased attention span

Question 4

Activities of daily living

Answer 4

bathing, grooming, dressing, mobility, toileting, eating, transferring

Question 5

Instrumental ADLs

Answer 5

telephone, meal prep, shopping, finances, stairs, reading, laundry, housework, transportation, meds, employment

Question 6

How often should lipids be screened?

Answer 6

every 5 years (more in CAD, DM, PAD, stroke hx)

Question 7

How often should bone density be screened?

Answer 7

women: at least once after 65
men: at least once after 70

Question 8

How often should mammogram be screened?

Answer 8

every 2 years for women 50-74

Question 9

How often should colonoscopy be done?

Answer 9

every 10 years from 50-75

Question 10

Med that should be taken by all geriatrics unless contraindicated

Answer 10

aspirin 81 mg QD

Question 11

How often should glucose be screened?

Answer 11

every 3 years in patients with BP > 135/80

Question 12

Screenings that should be done annually in older adults

Answer 12

Height/weight
BP
Vision
Hearing
Depression
Stool hemoccult
Dental care
Calcium intake
Safety counseling

Question 13

What is nociceptive pain?

Answer 13

arises in somatic or visceral tissue and described as aching, stabbing, or intense pressure and pain

Question 14

Meds with anti-cholinergic effects?

Answer 14

NSAIDs, Loop diuretics, H2-blockers, clonidine, opioids, SSRIs, TCAs, Benzos, Digitalis, beta-blockers (esp propranolol), fluoroquinolones

Question 15

How to treat nociceptive pain in elderly?

Answer 15

Mild: acetaminophen (less than 3 g/day) or tramadol; avoid NSAIDs!

Mod-severe: hydrocodone/ acetaminophen, oxycodone, morphine, fentanyl patch, methadone

Question 16

How should opioid-induced nausea be treated?

Answer 16

usually resolves in 48 hrscompazine, ondansetron, or haloperidol prn

Question 17

Side effects of opioid use? How can these be avoided?

Answer 17

nausea, sedation, respiratory depression, constipation, red pruritic rash (rare)
only use opioids for mod-severe pain, give small doses with slow titration

Question 18

How to treat neuropathic pain?

Answer 18

anticonvulsants (gabapentin), duloxetine, lidocaine topical patch

Question 19

The most disabling condition in geriatrics

Answer 19

immobility