Geriatrics + Pall Care

Question 1

First line medication for behavioural disturbance in dementia

Answer 1

Risperidone 0.25mf BD PRN
2nd line olanzapine 2,5mg OD
NEVER use first-gen antipsychotics if Lewy bodies, or Parkinsons

Question 2

Acute end of life pharmacological management (6)

Answer 2

1. Cease orals if relevant
2. Subcut morphine via syringe driver
3. Subcut midazolam via syringe driver
4. Subcut maxalon TDS
5. Subcut Hyoscine butylbromide PRN
6. Subcut Dexmethasone if relevant (brain, capsular)

Question 3

KFP: History for fitness to drive assessment (5)

Answer 3

1. History of recent driving accidents
2. Compliance with medication
3. Any recent syncope
4. Any hx of sleep disorder
5. If DM - hypo awareness, or history of hypos

Question 4

KFP: Examination for fitness to drive (3)

Answer 4

1. Visual assessment - acuity or field
2. Assess co-ordination
3. MMSE if not provided

Question 5

KFP: Other than hx and ex, what other tools can be used to assess fitness to drive (3)

Answer 5

1. Referral to OT for driving assessment
2. Collateral from relatives about driving ability
3. Evaluation of cognition via neuropsychiatric assessment with geriatrician

Question 6

KFP: Assesed patient not fit to drive. Management steps? (4)

Answer 6

1. Inform patient that they are not medical fit to drive
2. Advise patient to notify the state authority re the outcome
3. Offer assistance to look at alternative transport options (taxi subsidy if eligible)

Question 7

KFP: Non pharma Mx of dementia+agression (6)

Answer 7

1. Identify+Reduce triggers of aggression
2. Anxiety management (reassurance)
3. Provide calm, low stimulating environment
4. Simplify instructions when conversing
5. Provide familiar environment (photos, consistent staff)
6. Time orientation aids

Question 8

Phamarcological options for alzheimers dementia (3)

Answer 8

1. Oral donepezil OD
2. Oral Galantamine MR OD
3. Transdermal rivastigmine patch OD

Question 9

Features of Lewy Body Dementia (3)

Answer 9

Need 2 of 3:
1. Visual hallucinations
2. Spontaneous motor parkinsonism
3. Fluctuation in mental state (in absence of clear cause of delirium)

Question 10

Non pharma management of dementia (4)

Answer 10

1. Reduce impact on ADLs via support - refer to MyAgedCare
2. Promote physical health + SNAP
3. Review + rationalise medications
4. Discuss creating an Advanced Care Plan