geriatrics: TXs Flashcards
what drugs can cause orthostatic hypotension
anti-hypertesnives, diuretics antidepressants and antipsychotics (e.g. venlafaxine, duloxetine, risperidone, haloperidol)
what drug can cause permanent cerebellar damage and unsteadiness in long term use at therapeutic dose
phenytoin
orthostatic hypotension
non medical management
- avoid sudden movement
-water loading
- increase salt in diet
- compression stocking
keep legs elevated
- calf muscle excersises
orthostatic hypotension medical management and when given
fludocortisone, midodrine
only given when everything else has failed (eg taken off drugs that cause postural hypotension and had non medical management)
what drugs should be stopped in postural hypotension
diuretics, anti hypertensive, dopamine agonists, pregabalin, review anti-depressants
just in case medication for pain/sob
morphine 2mg hourly scut
just in case medication for distress/agitation
midazolam 2mg hourly scut
just in case medication for nausea
levomepromazine2.5mg hourly scut
just in case medication for respiratory secretions
hyoscine butylbromide 20mg hourly scut
if already on established background opioid?
use same opioid. 1/6 background dose as breakthrough prn dose
contraindications to opioids
severe renal function- talk to senior, consider alfentanil
how to work out scut dose of morphine
divide daily dose of morphine by two
alzheimers mild/moderate treatment
1st line: the three acetylcholinesterase inhibitors (donepezil, galantamine and rivastigmine)
2nd- memantine
alzheimers tx moderate/severe
moderate- memantine + anticholinesterase inhibitors
or just memantine if anti is contraindicared
severe- monotherapy of memantine
what is morphine contraindicated in
CKD
