Geriatrics and Palliative Care

Question 1

STOPP-START criteria in the comprehensive geriatric assessment. Which medicines should you consider stopping?

Answer 1

Metoclopramide

Domperidone

PPIs

Centrally acting anti-hypertensives: methyldopa, clonidine, moxonidine

Non selective b-blockers - with a history of bradycardia, heart block, heart failure, asthma

Constipating drugs: anticholinergics, oral iron,opioids, verapamil
Amoiodarone

Antimotility drugs - if there is blood/mucus PR/ high fever in gastroenteritis

Simple antacids when used long term

Question 2

STOPP-START criteria in the CGA - what should you consider starting?

Answer 2

Antihypertensives >160/90 or >140 /90 if diabetic

B-blocker/ CCB for stable angina. B-blocker for systolic heart failure.

ACE.I for systolic HF or coronary disease

Statins

Question 3

What can you use for hiccups in palliative care?

Answer 3

Haloperidol or chlorpromazine

Question 4

What is the major side effect of donepezil to be aware of?

Answer 4

Bradycardia

Question 5

Mechanism of action of memantine?

Answer 5

NMDA antagonist

Question 6

Which type of dementia produces global deficits in the ACE test?

Answer 6

Alzheimer’s

Question 7

Which type of dementia primarily shows deficits in the fluency and language sections of the ACE?

Answer 7

Frontotemporal

Question 8

Which type of dementia causes deficits in the visupospatial part of the ACE as well as memory and attention?

Answer 8

Parkinson’s dementia

Question 9

Which type of dementia classically invovles: visual hallucinations, decline in mobility/ parkinsonism and fluctuant cognitive decline?

Answer 9

Lewy body dementia

LBD encompasses: Dementia with lewy bodies and parkinson’s dementia.

These overlap but the difference is:
Dementia with lewy bodies - dementia first, parkinsonism later
Parkinson’s dementia - physical symptoms first

Question 10

What are the preferred opioids in CKD?

Answer 10

Alfentanil, fentanyl and buprenorphine

Question 11

Which anti-emetic for intracranial causes of N&V?

Answer 11

Cyclizine (H1 receptor antagonist)

Question 12

Which anti-emetics for gastric status?

Answer 12

Metoclopramide and domperidone

Question 13

Which anti-emetic for nausea caused by drugs and toxins?

Answer 13

Metoclopramide and haloperidol

Question 14

Which anti-emetic for vestibular causes of N&V?

Answer 14

Cyclizine, prochlorperazine, metoclopramide

Question 15

Which anti-emetic for chemically mediated N&V ? (High Ca2+, opioids, chemo etc)

Answer 15

Ondansetron, levomepromazine, haloperidol

Question 16

What is the first line oral drug for confusion and agitation in palliative care when the oral route is still an option?

Answer 16

Haloperidol

2nd line: chlorpromazine, levomepromazine

Question 17

How do you convert from oral codeine to oral morphine?

Answer 17

Divide dose by 10

E.g 30mg codeine= 3mg morphine

Question 18

How do you convert from oral tramadol to oral morphine?

Answer 18

Divide dose by 10

Question 19

How do you covert from oral morphine to oral oxycodone?

Answer 19

Divide by 1.5 - 2