Geris + Palliative

Question 1

Rx for mild, moderate and severe dementia

Answer 1

Mild to moderate - donepezil, galantamine, rivastigmine acetylcholinesterase inhibitors
Moderate to severe - add memantine
MMSE - <10 severe, 10-20 moderate, >20 mild

Question 2

Breakthrough morphine dose

Answer 2

1/6 of total daily dose

Question 3

Visual hallucinations plus dementia ?

Answer 3

Lewy Body dementia

Question 4

Difference between Parkinson’s and Lewy body dementia?

Answer 4

In parkinson’s motor symptoms precede cognitive decline

Question 5

Analgesia of choice in renal impairment

Answer 5

Mild to moderate - oxycodone
Severe - buprenorphine or fentanyl

Question 6

sporadic alzheimer’s disease genetic determinant?

Answer 6

The ε4 allele of the APOE gene

Question 7

metastatic bone pain not controlled with analgesia

Answer 7

morphine / bisphononates / radiotherapy. Usually in the stem opiates have been trialled hence next option is bisphonates due to quicker onset of action

Question 8

Drug of choice for oral pain

Answer 8

Benzydamine mouth wash

Question 9

Medications to avoid in Parkinson’s

Answer 9

HARM - Haloperidol, Antipsychotics, pRocholperazine, Metoclopramide

Question 10

Role of anticholinesterase in Dementia

Answer 10

Improvement in daily activities