Geris lectures Flashcards
Key deteriorating intrinsic factor that predisposes to falls?
vestibular function deteriorates–>more dependent on vision
timed get up and go tests
if more than 10 secs descriminates faller from non falle
strongest visual RF for falls
depth perception
How to use a cane?
Hold cane on good side
bring cane forward when step with bad leg
to go up stairs “up with the good”
to go down stairs “down with the bad”
systemic oestrogen therapy for incontinence?
Worsens
M1 blockade
impaired memory and cognition
M2 bllockade
Prolong QT
M3 blockade
dry mouth, constipation, blurred vision
M4
impaired cognition
M5
nothing
Solifenacin MOA
Darifenacin MOA
Block M3 alone
more constipating
no cognition effect
Darifenacin is the most M3 selective
Drug of choice for management of behavioural and psych symptoms of dementia?
but then americans say haloperidol
atypicals: probbaly benefit when doses used larger. at small doses no benefit atypicals over haloperidol. atypicals fewer extrapyramidal side effects if using over 4.5 haloperidol
but risky
panadol some evidence
What can urinary flow rates not distinguish?
detrusor underactivity (ie diabetic neuropathy) vs outflow obstruction
benefit of patch oyxybutynin?
bypasses first pass metab
reduces dry mouth ++
How to manage detrusor overactivity in BPH?
alpha blockers for BPH= prazosin, tamsulosin
idea is that overactive bladder may be due to BPH
Why is oestrogen important in incontinence?
Oestrogen usually modulates adreneergic receptors in the bladder. If replacem then ther eis increasing contractile support which prevents urethral hypermobility
What is Mirabegron?
beta3 agonist–>bladder relaxation
fewer side effects than anticholinergics
treatment for detrusor underactivity
NOT cholinergics
treat constipation
catheterisation if poor emptying
stress incontinence treatmenta?Q
MINIMISE RISK FACTORS LIKEweight and constipation
pelvic floor
topical oestrogens
surgery
ApoE2, 3?
protective 2
neutral 3
wORST predictors of delirium?
restraint use
malnutrition
(more than dementia, catheter, new meds, dehydration, lines, dehydration)
But then list of 6 overall: prior cog imp sleep dep immobility visual imp hearing imp dehydration
New antidepressant vortioxetine MOA
serotonin 5HT1A AGONIST- stimulate and modulate
Ketamine acts at
glutamate NMDA receptors
Duration antidepressant:
stay at effective dose 6-12 months ist ep
recurrent - stay at effective dose 3-5 years
no data beyond this
