Geriatrics Flashcards

Question

WHAT is Depakote

Answer 1

It is an ANTI-CONVULSANT but... Also a Mood Stabilizer, try instead of an antipsychotic in elderly BiPolars/Schitzos Also helps with headaches and it's primary use is Anti-Seizure

Answer 2

Alpha 1 Blockers Prazosis (Minipress) Tamulosin (Flowmax)

Answer 3

Certaline (Zoloft) | Escitalopram (Lexapro)

Answer 4

Fronto-Temporal Lobe Dementia or PICKS Dz shrinks the frontal and temporal lobes visibly on MRI Caused by protein malfunction, mainly genetic predisposition

Answer 5

``` Pneumonia UTI Shingles C Dif Influenza VRE: Vanco Resistant Enterococcus Intestines, UTI + Wounds (does live on skin) Use Dapto & Linezolid MRSA ```

Answer 6

Daptomycin | Dapto causes Rhabo so watch BUN/Cr

Answer 7

Flagyl or | Vancomycin PO - only PO use of vanco

Answer 8

Tamiflu if under 72 hrs (3 days)

Answer 9

Meniere's Dz Low Salt + Diuretics

Answer 10

Strep Pneumo: Macrolide or Doxy

Answer 11

Benign Paroxismal Positional Vertigo Dix-Halpike TEST is the Dx - Nystagmus on fall back from sitting with legs out Eply Maneuver is the treatment

Answer 12

Azithromycin or Doxy

Answer 13

Vanco + Levofloxacin + Imipenem Hospital acquired is high risk for multi drug resistance. Risk increases with length of stat, over 5 days fear the worst and hit your pt with all three. Low Risk: Levofloxacin alone or Macrolide + 3rd Gen (Azithro + Rocephin)

Answer 14

Bactrim DS Cipro Nitrofurantoin (GFR over 60) Cephalexin (Keflex 1st generation Cephalo)

Answer 15

``` Arthritis Osteoporosis/Compression Fracture AAA Kidney Infection/UTI Muscle Strain Reticulopathy and/or herniated disc Spinal Stenosis - shopping cart folks Sciatica Cancer mets to the spine ```

Answer 16

Mesenteric Colitis/Ischemic Colitis - High Serum Lactate in late/severe ischemia AAA Diverticulitis Constipation Ischemic Colitis - CT w/contr, Colonoscopy is Dx Mesenteric Ischemia - need Angiogram, its a vessel blockage cau

Answer 17

Mesenteric Ischemia is reduced blood flow to the small intestine and colonic ischemia is obviously reduction in bf to the colon When the colon has reduced supply, it hurts (colitis) This is visible on a colonoscopy and there may bloody diarrhea - but really you want to do an angiogram to spot the blockage. Acute onset is usually caused either by a clot (usually a cholesterol clot and pt will have known CAD already) or it can be caused by vasoconstriction of the mesenteric arteries by vasopressors during shock treatment Chronic onset is usually d/t Atherosclerosis and presents as pain, often @ splenic flexure or left side, 15-30 min after a meal lasting 6 hours, throughout the attempt at digestion. There is Mesenteric is decreased blood flow to the sm bowel Acute: clot Abdominal Pain out of proportion to the exam, narcotics don't help Chronic: Atherosclerosis Colonic is decreased blood flow to the colon Pain and discomfort often at the splenic flexure with bloody Diarrhea (red)

Answer 18

Acoustic Neuroma: Tumor on Cr 8 Get MRI

Answer 19

Sulfonureas: Glipizide, Glimeperide Insulin

Answer 20

Predicts Pressure Point Risk: 1) Does Pt FEEL pressure? 2) Is area exposed to MOISTURE? 3) Is Pt IMMOBILE? 4) Does Pt EAT enough? 5) Friction & Shear - can Pt move himself over the sheets of must he be dragged? Staff should use a draw sheet to move such a patient to prevent friction + shear

Answer 21

1) Hyperemia - redness occurring after an 30 minutes of pressure, disappears an hour after pressure is removed. BLANCHABLE 2) Ischemia - O2 starvation caused by 2-6 hours of continuous pressure. Hurts - may take 36 hrs to disappear LESS BLANCHABLE 3) Necrosis - Cell death occurring after 6 hrs of continuous pressure. Skin turns blue/grey and indurated (hard). NON-BLANCHABLE 4) Ulceration - occurs days up to 2 weeks after Necrosis, may become infected

Answer 22

Stage 1) Red, blanchable, Skin intact Stage 2) Skin not intact, blister/ulcer through epidermis/superficial dermis. Blanchable because blood supply in deep dermis is not yet compromised Stage 3) Blood Supply, nerves and glands are eaten through all the way to the muscle. Non-Blanchable and usually not painful because the nerves are dead. Slough is classic stage 3 though if it obscures the bottom of the sore, it makes the wound unstagable Stage 4) Through the Muscle to the Bone. Slough + Eschar may be present UnStagable - you cannot see the "bottom" of the ulcer - slough or eschar in the way

Answer 23

Slough is classic stage III, white (uninfected) to yellow/green/brown (varying stages of infection) stringing goo which could possibly be taken for connective tissue/tendon but isn't. Eschar is black. If you see anything black, its eschar. Early eschar is HARD but once bacteria set it, it gets boggy + soft. Late eschar is soft and known as UNSTABLE ESCHAR.

Answer 24

It is a cardiac risk in the elderly (and the NP said in everyone) Give it IM in Dementia Emergencies Its an antipsychotic and an anti-emetic

Answer 25

Over Flow In Females, Overflow is usually caused by a neural problem like MS or Diabetic Neuropathy. It could also be caused in females or males by a urethral stricture that makes emptying a problem such that the bladder swells beyond its capacity with overflow leaking out. Bladder retention could be the issue in either sex, look for an anticholinergic medication that could cause urinary retention. Of course, the overfull bladder can reflux urine up into the kidney if it can't dribble it out the urethra.

Answer 26

Over Active Bladder, UTI or even uterine prolapse in females Rx is an Anticholinergic to relax the detrusor muscle

Answer 27

The water works are fine but GETTING to the bathroom is difficult. Regular toileting with assistance or a commode should help. Perhaps PT to increase strength and pain control? Loose those statins if they're on board to stop any rhabdo/weakness they may be causing.

Answer 28

MOST COMMON incontinence in females pelvic floor and sphincter muscles weaken as well as uterine prolapse. Obesity inherently weakens the pelvic floor and is a huge risk for stress incontinence. If prolapse, Hysterectomy may help, Kegals, even some stem cell inoculation of the sphincter muscle is being done in europe, not here though. Have to travel. New mycotes form and their strong + young!

Answer 29

Incontinence control Anticholinergics, both blocks muscarinic receptors and prevent contraction of smooth muscle. Oxybutynin blocks all 3 Muscarinic receptors and is 1/5 as strong as Atropine. Tolteradine only blocks M2 + M3 Causes the whole host of Anticholinergic (Mad as a Hatter, dry as a bone, hot as a hare, blind as a bat, red as a beet) rxns ALWAYS clear closed angle glaucoma before using, NEVER with MYASTHENIA GRAVIS Will worsten overflow incontinence as it will cause further stasis of the detrusor.

Answer 30

``` Female Fat SMOKING Childbirth Post Menopausal Estrogen Defecit BPH or Prostatitis Diabetes Nerve Disorders: MS, Spinal Trauma ```

Answer 31

All the Antis: ``` Anticholinergics Antihistamines Antidepressants Antipsychotics Benzos ``` Alpha Agonists: Pseudophedrine can cause the sphincter to constrict causing overflow Alpha Blockers: Zosins may over relax the prostate.... Colchecine can cause urge incontinence Diuretics may lead to large volumes being introduced into the bladder on short notice, increasing functional and or urge incontinence

Answer 32

-ine likely anticholinergic -one antispasmodics/ amiodarone-esq anti arrhythmic and HORMONES -ide antiarrythmics + Sulfonureas -bital phenobarb sedatives, OD risk esp in liver dz/compromise -Pams or -Poxides = Benzos reduced elimination increases fall/delirium risk - All NSAIDS and Aspirin cause gastric ulcers take with omeprazole if they must be given

Answer 33

Bad for Elderly Its an Insomnia med./ hypnotic Replace with Trazadone (an SARI) for sleepless delirium

Answer 34

Acute Closed Angle Glaucoma Presentation: Elderly w/presbyopia but no dx of glaucoma. Boring, periorbiatal pain w/vision deficits HA on same side as eye pain N/V may occur Anticholinergics can cause it as can dim lighting (emerging from movie theater..)

Answer 35

TriCyclics - brugada like formations on keg Erythromycin

Answer 36

Mobility in under 10 seconds Timed Up + Go Around the cone and back in under 10!

Answer 37

Hips Wrists + Spine

Answer 38

Beyond Beers criteria for elder drug problems incorporates replacements

Answer 39

Hyponatremia DON'T use Prozac or Paxil Do try Certaline (Zoloft) or Lexapro instead

Answer 40

CAM Assessment Confusion Assessment method Acute Onset change in mental status Change fluctuates throughout interview _______________________both required____ Disorganized Thinking Hallucinations Sleep Wake reversal _______ 2 required________________

Answer 41

Depakote is (believe it or not) safer

Answer 42

Mild Cognitive Impairment

Answer 43

Hospice: Terminal Dx required, no aggressive life saving methods, pain management Palliative: No particular Dx required, aggressive life saving possible

Answer 44

Tylenol (day) or Tramadol (night w/depends) Don't exceed 300mg of Tramadol daily in Pts over 75 Celecoxib + Miloxicam are cox2 selective NSAIDS which could be used

Answer 45

prevent falls

Answer 46

1X Carotid doppler between 65-66 1X AAA Abd Doppler between 65-66

Answer 47

Spinal Compression Fracture Look to see that spine gets wider as you go down, pay attention to suspicious looking vertebrae

Answer 48

Dakin Soln (Sodium Hypochlorite - bleach) Weak bleach debrides and disinfects gently, then apply wet to dry dressings moistened with NS.

Answer 49

GET A CAROTID DOPPLER

Answer 50

``` Age Poor Lifestyle Low Education Mental Retardation Syphyllis Head Trauma aPO e4 mutation Presenillin 1 mutation for early onset ALZ ```

Answer 51

IV to Elders Also use a reduced dosage in elders 0.5-1mg only

Answer 52

``` Depression Hearing loss Syphyllis Hypothyroid Thymine/B9 and B12 Deficiency TBI ```

Answer 53

Anesthesia

Answer 54

Present in 70% of early onset Alzheimers

Answer 55

Causes stroke in elders, use Quetiapine instead for antipsychotic/Schitzo/Disordered thought in elders

Answer 56

Lasix Its an NMDA Blocker used in Alzheimers and Parkinsons aka Namenda monitor renal function if using memantine in elders

Answer 57

UTI See delirium, check UA/UC

Answer 58

NO! Give colace or prune juice + increase fluids!

Answer 59

``` LET THEM SLEEP! -No Vitals at night -No TV after 8 -No Nonemergent Labs at night -Promote Day/Night orientation with window shades up during day --Assist with meals + offer snacks -Get up out of bed for all meals -Bladder scan if no urine in 6 hrs, strait cath if retention is identified -Notify MD if no BM 3 days -Offer fluid dq2hs unless NPO ```

Answer 60

3 blocks (1000 feet) carry 6.7lbs navigate stairs curbs in + out of tub

Answer 61

65% of strength lost Unintentional Wt loss of 10+ lbs in last year Exhaustion Sedentary/Sitting less than 8 chair stands in 30 seconds

Answer 62

All Cause constipation

Answer 63

GAIT 4 meters in less than 6.2 seconds

Answer 64

Rapid onset w/fluctuating course Primary deficit is attention, not memory Dementia can coexist May be Hypo or Hyper Active

Answer 65

Don't exceed 0.125 mg/day Risk: Brady with the sloped RS wave

Answer 66

DANGEROUS!!! The 1st 6-12 months is very likely to kill you ``` infection risk AV fistula risk Lethargy Pain Itching Dizziness GI Disturbance Torsades Peritonitis (for Peritoneal dialysis) ```

Answer 67

``` Arterial Dz: 1) Atherosclerosis 2) Smoking Damage to arterial wall elasticity Lower legs are 3) Reynauds ``` SXS: Dusky Cool Extremities & Claudication. Dangling should make it better, elevation makes it worse. More likely to be unilateral than venous dz. Venous Dz: 1) Chronic Venous Insufficiency: Valve Damage leads to swelling, edema, bronzing in feet, calves 2) DVT 3) PE 4) Thrombophlebitis 5) Varicose Veins SXS: Bronzing, Itching + Edema, dull achy, cordy varicosities

Answer 68

Normal Na+ is 135-145 mEq/L Signs + Sxs of hyponatremia range from nausea + malaise all the way to altered level of consciousness, seizure + coma d/t brain edema and even brain herniation and death! Antipsychotics and Diuretics are often the culprit as well as OVERHYDRATION and low salt diet. Thiazides are more prone to causing low Na+ than are LOOPS. Ultraendurance runners, especially females are candidates for hypo Na+ as are post surgical pts (d/t irrigation and or over hydration) ORGAN FAILURE: CHF, Liver, Renal as well as Pneumonia are common causes of Hyponatremia Get Orthostatic Bps, a CBC/CMP to establish volume status and do a full exam with special eye out for CHF, Renal and Liver issues. Consider Volume Overload (if on IV or a renal patient) Consider Cerebral Salt Wasting CSW caused by increased ICP d/t cerebral hemorrhage of swelling and consider the Kidneys a very likely source for the problem. Don't forget to consider SIADH (syndrome of inappropriate ADH secretion) if there is no CHF, no renal dz or impairment, no liver impairment and no thyroid impairment and urine osmolarity is over 100, more like 400-500.

Answer 69

Central HTN control Clonadine Reserpine Methyl Dopa May cause orthostatic hypotension as well as bradycardia

Answer 70

Pulmonary Fibrosis

Answer 71

Stroke risk

Answer 72

Cholinergic (OK to use) for Open Angle Glaucoma Peripheral vision loss, increased cup to disc ratio. Pilocarpine causes constriction of the pupil opening up the schwaans canal

Answer 73

Donepezil Rivastigmine - aCHesterase inhibitor Can also use in parkinsons late: Memantine (not with lasix, renal risk)