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GEN MED III > Geriatrics > Flashcards

Geriatrics Flashcards

1
Q

Mini Mental Scoring Tips

Above 24 is great

Below 18 is bad

18-23 is Mild Impairment

A

6 Pts: House/Car/Dog
3 for remembering them at the start
3 for remembering them after 5 min
5 Pts Each for:
5 TIME: Date/Month/Hour of which day
5 PLACE: where are we?
5 COUNTING BkWards by 7s
or spelling WORLD backwards

3 Pts: Folding
2 Pts: 2 Object Naming

EVERYTHING ELSE IS 1pt !!!

24-30 = No Cognitive Impairment
18-23 = Mild Cognitive Impairment (MCI)
Below 18 = Severe Impairment

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2
Q

Domains to assess in Elders

A

Physical
Cognitive
Psychological
Social

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3
Q

Quick Mobility Assessment in Elders

A

TUG Test
Timed
Up and
Go

3 meters between a chair and a cone. Elder is to rise, navigate around the cone and back to seated in less than 12 (she says 10, 12 is too high) seconds.

May use assistive device

Do 1 practice then 2 tests and average

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4
Q

Drug Classes that Cause MOST of the problems for Elders

A 
•  Antidepressants
•  Antipsychotic drugs
    Anticholinergics
•  Cardiac medications
•  Hypoglycemic agents
*  Benzodiazepines
*  Statins
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5
Q

quick Elder test for Leg Strength

A

CHAIR STAND

Arms Crossed over chest
Raise from seated + Return at least 8X in 30 Seconds

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6
Q

Frailty Criteria

A

Wt Loss - UN-intentional, over 10 lbs in yr

Exhaustion - Self Described

           - Low Energy (low interest/ability)
           - Tired
           - Weak

Sedentary (expends less than 270KCal female/
or 383 Kcal for males) self report
by activity scale.

Slow - 4 meters in more than 6.2 seconds

Strength - Fewer than 8 chair stands in 30 Sec

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7
Q

The SIXTH vital sign?

A

Gait Speed

Stay above 4 meters in 6.2 seconds!

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8
Q

Assume Frailty if…

A

Pt leaves home fewer than 3X / week

Prescribe walking program at the mall or local high school and help Pt ensure transportation.

Prescribe an odometer and make them bring it in at every visit or figure out how to have them send their fit bit results to you via email

You can also get BG record programs that can send to you daily or weekly BG reports via the internet - LEARN HOW TO IMPLEMENT these programs!!

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9
Q

How many steps should a person take a week

A

5000/week

2000/day

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10
Q

How to open a conversation with an Elder about improving fitness:

A

“Can you tell me how long you think you’ll live?”

“Ok, so you have ____ good years left, How are you going to use them?”

“To be able to use your remaining years as you’d like, we’ll need to increase your strength and fitness to ensure you have at least some reserve strength to call upon in a crisis such as if you get sick or if you’re injured”

Plan:

1) Assess Gait with 4m/6.2 second test
2) Assess Mobility with the TUG test
3) Assess Strength with the Chair Test
4) Assess for Depression/Dementia and
consider treating for depression
with a geriatric friendly SSRI
5) Catalog Pts complaints: energy, strength
loneliness, comorbidities
6) Review Meds and see what you can
Remove
7) Get them UP and Walking or at least
MOVING in some organized program
Assure Transportation
Consider cardiac rehab - ins may
pay for this and they’d get 6 weeks
with a PT and nurse supervising
their program
8) Make END OF LIFE care plan:
IN WRITING, a DNR if that’s what they
want, a LIVING WILL to spell out
the boundaries of care they wish to
receive. Specifically address:
-CPR
-Resuscitation Drugs like
Epi/Amiodarone/Pressors/Atropine
-NGT/ IV feeding IV fluids
- Oxygen Therapy
-Respirator Support
- Surgeries
- Imaging that would only be helpful
if surgery were a treatment option. If
you’re not going to have a surgery to
correct a situation, don’t do the imaging.

These directives would of course be moot if the patient was alert enough to make each one of these health care decisions. They are to guide the healthcare proxy if the pt is not competent or alert enough to make these decisions. By all means, if alert and the pt falls and an Xray needs to be done, Pt can consent to the X-Ray. If Pt is unconscious and states no imaging that would lead to surgery, well then, no, no X-Ray.

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11
Q

Elders of all ages SHOULD be able to:

Walk (how far?)

Carry (how much?)

Navigate (what obstacles)

A

Walk 3 blocks, 1/4 mi, 1000 feet

Carry 6.7 lbs

Manage stairs, curbs, getting in + out of the tub

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12
Q

What to do if you discover Pt has Balance problems or Fall Risks?

A

Write a Prescription for PT with the most Strident therapist you know.

Get them stronger, moving and trained on how to get up after a fall.

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13
Q

What % loss of strength heralds Frailty?

A

65% is the line so anything above it is in the realm of frailty.

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14
Q

ADLs vs IADLs

A

ADLs are very basic: Feeding oneself, toileting + bathing.

IADLs allow a person to live independently. Think of the ‘I’ as meaning independence, though it actually stands for instrumental.

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15
Q

Alzheimer’s Disease vs Alzheimer’s Dementia

A

Alzheimers Disease vs Alzheimers Dementia

The Disease state is brought about by the deposit of beta-amyloid plaques and protein tangles in the brain tissue

This eventually results in cognitive, psychological and social deficits.

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16
Q

Uses/Problems with anticholinergics in elderly

A

Used to reduce secretions (scopolamine ) and anti spasmodic to slow bowel (Dicyclomine/Bentyl)

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17
Q

scopolamine uses

A

To counter Clozapine drooling

nausea/motion sickness

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18
Q

Why not use Dipyridamole in Elders?

A

Causes Orthostatic Hypotension

Short Acting AntiThrombotic (long acting is ok) t

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19
Q

Why not Nitrofurantoin for elders?

A

If Cr Cl is less than 60, the med doesn’t get concentrated enough in the urine to kill the UTI bug.

It’s renally cleared and if kidneys aren’t functioning, it can build up in the blood to a level that may cause a PULMONARY HYPERSENSISTIVITY rxn that looks a lot like PNEUMONIA or non-cardiogenic pulmonary edema but goes away when the drug is stopped.

To be clear, Nitrofurantoin is great for straight up E.Coli and there’s almost NO RESISTANCE but the kidneys have to work well enough to concentrate the drug in the Urine. Its really an amazing drug that way, does not stay long in the blood at all, goes straight to the bladder.

Its OK in pregnancy UP TO WEEK 38, thereafter it isn’t broken down by the placenta and the fetus has to do it and the fetus doesn’t have the right enzyme to metabolize the drug and could end up getting hemolytic anemia from it. Thats why babies under 1 month should not be given Nitrofurantoin either. They develop the needed enzyme (Glutathione) at about a month.

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20
Q

What CAN we do to Alpha Receptors in the Elderly?

A

NOTHING

Both Blockers (the rosins) and Agonists (HTN Meds: Clonadine, MethylDopa, Reserpine) cause problems for Elders:

While Alpha Blockers lower BP by BLOCKING A1 Receptors in peripheral vasculature and preventing constriction, they cause ORTHOSTATIC HYPOTENSION for most people. Elders are even more prone to Orthostatic BP falls due to loss of elasticity in their veins and thus get a double whammy

Alpha Agonists lower BP by stimulating ALPHA 2 receptors in the CNS, this then results in RELAXATION of peripheral vasculature. Again, messing around with the diameter of peripheral vasculature in Elders is dicey - their veins just aren’t stretchy or responsive enough anymore and Orthostatic Hypotention will likely result.

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21
Q

Which class of Anti Arrythmics CAN you use in the elderly?

A

1b: Lidocaine + Phentoin (Dilantin)

ALL class 1 antiarrythmics are Na+ Channel Modifiers.  
     Class 1a (QUINIDINE, DISOPYRAMIDE) lowers the threshold before the Na+ gates open .
     Class 1c: Flecanide + Propophenone, prolongs DePolarization, making it take longer to move a signal along.
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22
Q

Presbycusis

A

Presbycusis

Presby= Elder (think church)
Cusis = think aCOUStic
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23
Q

SARI for Elderly Insomnia

A

Trazadone

(Serotonin ANtagonist AND Reuptake Inhibitor)

Very nice for Delerium and Insomnia

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24
Q

CAM criteria

A

Confusion Assessment Method for assessing Delirium

Acute Onset?
Fluctuating mental status?
     Must have both for Delirium plus either/or
Disorganized Thinking
and/or
Altered Level of Consciousness
       Alert
       Drowsy
       Stupor
       Coma

If they have 1+2 and either 3 or 4, you have Delirium

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25
Q

WHAT is Depakote

A

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

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26
Q

BPH drugs that cause orthostatic hypotension

A

Alpha 1 Blockers
Prazosis (Minipress)
Tamulosin (Flowmax)

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27
Q

Cataract risk drug class

A

Steroids

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28
Q

SSRIs safer for Elders?

A

Certaline (Zoloft)

Escitalopram (Lexapro)

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29
Q

Dementia wherein Social Graces and Judgment go first

A

Fronto-Temporal Lobe Dementia or PICKS Dz

shrinks the frontal and temporal lobes visibly on MRI

Caused by protein malfunction, mainly genetic predisposition

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30
Q

Common Infections in the Elderly

A 
Pneumonia
UTI
Shingles
C Dif
Influenza
VRE:  Vanco Resistant Enterococcus
          Intestines, UTI + Wounds (does live on
          skin)  Use Dapto & Linezolid
MRSA
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31
Q

How to kill VRE

A

Daptomycin

Dapto causes Rhabo so watch BUN/Cr

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32
Q

1st Line for MRSA

A

Vanco

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33
Q

1st line for c Dif

A

Flagyl or

Vancomycin PO - only PO use of vanco

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34
Q

Influenza Rx

A

Tamiflu if under 72 hrs (3 days)

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35
Q

Shingles

A

Acyclovir

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36
Q

Tinnitis, vertigo & fullness in the ear on one side

A

Meniere’s Dz

Low Salt + Diuretics

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37
Q

Rust Colored Sputum Pneumo:

A

Strep Pneumo: Macrolide or Doxy

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38
Q

BPPV?

A

Benign Paroxismal Positional Vertigo

Dix-Halpike TEST is the Dx - Nystagmus on fall back from sitting with legs out

Eply Maneuver is the treatment

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39
Q

Chlamydia Pneumo

A

Azithromycin or Doxy

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40
Q

Hospital Acquired Pneumo

A

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)

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41
Q

UTI drugs for elderly

A

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

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42
Q

Causes of Low Back Pain in Elders

A 
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
43
Q

Abd pain in Elders

A

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

44
Q

Mesenteric vs Colonic Ischemia vs Ischemic Colitis?

A

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)

45
Q

Unilateral Tinnitis, Unilateral Facial paralysis and gradual unilateral hearing loss

A

Acoustic Neuroma: Tumor on Cr 8

Get MRI

46
Q

Glycemic Agents most likely to cause Hypoglycemia

A

Sulfonureas: Glipizide, Glimeperide

Insulin

47
Q

Braden Scale

A

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

48
Q

4 levels of skin break down

A

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

49
Q

Staging of DeCubitus/Pressure Ulcers

A

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

50
Q

Slough vs Eschar

A

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.

51
Q

Why not give Haloperidol (Haldol) IV?

A

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

52
Q

incontinence associated with BPH

A

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.

53
Q

Urge Incontinence caused by

A

Over Active Bladder, UTI or even uterine prolapse in females

Rx is an Anticholinergic to relax the detrusor muscle

54
Q

Functional Incontinence

A

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.

55
Q

Stress incontinence

A

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!

56
Q

Oxybutynin, used for what?

Tolteradine

A

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.

57
Q

INCONTINENCE RISKS

A 
Female
Fat
SMOKING
Childbirth
Post Menopausal Estrogen Defecit
BPH or Prostatitis
Diabetes
Nerve Disorders:  MS, Spinal Trauma
58
Q

Meds that cause incontinence

A

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

59
Q

Avoid meds that end in:

Ine
One 
Ide
BiTal
Pam
Poxide
Zosin
A

-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
60
Q

Choral Hydrate

A

Bad for Elderly

Its an Insomnia med./ hypnotic

Replace with Trazadone (an SARI) for sleepless delirium

61
Q

Emergent Eye 911

A

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..)

62
Q

Cause prolonged QT

A

TriCyclics - brugada like formations on keg

Erythromycin

63
Q

TUG test for

A

Mobility in under 10 seconds

Timed Up + Go

Around the cone and back in under 10!

64
Q

Most common Elder fractures

A

Hips Wrists + Spine

65
Q

drugs above which an elder is thought to risk polypharmacy

A

4

66
Q

START + STOPP Criteria

A

Beyond Beers criteria for elder drug problems incorporates replacements

67
Q

SSRI risk in Elders

A

Hyponatremia

DON’T use Prozac or Paxil

Do try Certaline (Zoloft) or Lexapro instead

68
Q

Accurately assesses Delirium in 95% of cases

A

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________________

69
Q

Alternative to antipsychotic for elders

A

Depakote is (believe it or not) safer

70
Q

Deficits in cognition without deficits in ADLs

A

Mild Cognitive Impairment

71
Q

Hospice vs Palliative Care

A

Hospice: Terminal Dx required, no aggressive life saving methods, pain management

Palliative: No particular Dx required, aggressive life saving possible

72
Q

Mild pain in elders

A

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

73
Q

If using benzos to sleep, do use depends to

A

prevent falls

74
Q

New things you get to SCREEN for on the Welcome to Medicare Exam since 2012

A

1X Carotid doppler between 65-66

1X AAA Abd Doppler between 65-66

75
Q

Falls on the Butt cause

A

Spinal Compression Fracture

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

76
Q

Med that Causes Tinnitis

A

Aspirin

77
Q

Use this to cleanse pressure ulcers

A

Dakin Soln (Sodium Hypochlorite - bleach)

Weak bleach debrides and disinfects gently, then apply wet to dry dressings moistened with NS.

78
Q

If you hear bruits…

A

GET A CAROTID DOPPLER

79
Q

Dementia Risks

A 
Age
Poor Lifestyle
Low Education
Mental Retardation
Syphyllis
Head Trauma
aPO e4 mutation
Presenillin 1 mutation for early onset ALZ
80
Q

Never give Haldol/Haloperidol ….

A

IV to Elders

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

81
Q

Look like dementia

A 
Depression
Hearing loss
Syphyllis
Hypothyroid
Thymine/B9  and B12 Deficiency
TBI
82
Q

Common Hospital Rx that precipitates Dementia

A

Anesthesia

83
Q

Significance of Presenilin 1 Mutations

A

Present in 70% of early onset Alzheimers

84
Q

Rispridol risk

A

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

85
Q

Never use Memantine with

A

Lasix

Its an NMDA Blocker used in Alzheimers and Parkinsons

aka Namenda

monitor renal function if using memantine in elders

86
Q

1 Cause of delirium in Alz Pts

A

UTI

See delirium, check UA/UC

87
Q

Metamucil for elders?

A

NO!

Give colace or prune juice + increase fluids!

88
Q

Delirium Protocol

A 
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
89
Q

Elders should be able to walk/carry/navigate:

A

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

90
Q

This %age loss = Frailty

A

65% of strength lost
Unintentional Wt loss of 10+ lbs in last year
Exhaustion
Sedentary/Sitting

less than 8 chair stands in 30 seconds

91
Q 
Opiates
Nifedapine
Antihistamines 1st gen
Anticholinergics
Antipsychotics
Tricyclics
A

All Cause constipation

92
Q

The Sixth Vital Sign

A

GAIT 4 meters in less than 6.2 seconds

93
Q

Contraindication to Dementia Dx

A

Delirium

94
Q

Delirium Dx

A

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

95
Q

Digoxin dose

A

Don’t exceed 0.125 mg/day

Risk: Brady with the sloped RS wave

96
Q

Dialysis is…

A

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)
97
Q

PVD - Peripheral Vascular Dz encompasses

A 
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

98
Q

Hyponatremia:

Normal Range Na+?

Signs + Sxs

Common Causes in Elderly?

A

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.

99
Q

Alpha 2 Agonists

A

Central HTN control

Clonadine
Reserpine
Methyl Dopa

May cause orthostatic hypotension as well as bradycardia

100
Q

Amiodarone

A

Pulmonary Fibrosis

101
Q

Antipsychotics

A

Stroke risk

102
Q

Pilocarpine

A

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

103
Q

Early/Late Alzheimers

A

Donepezil
Rivastigmine - aCHesterase inhibitor
Can also use in parkinsons

late: Memantine (not with lasix, renal risk)

GEN MED III (7 decks)

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