Geris/PC Flashcards
Which drugs are associated with osteoporosis?
Corticosteroids Heparin Cyclosporin Methotrexate, and Cytotoxic therapy.
List some of the causes of dementia
Syphilis Vitamin B12 deficiency Folate deficiency Pellagra Vascular disease HIV Multiple sclerosis
Which drugs increase the risk of hypothermia?
chlorpromazine/benzodiazepines
What dose would you give for paracetamol?
Paracetamol
– 1g QDS (4 hourly) – maximum 4g in 24 hours
– Reduce to 500mg QDS if <50kg, renal/liver failure
PRN codeine 30-60 mg
What dose would you give for an NSAID?
NSAID
– Ibuprofen 400mg TDS max 2.4g/day
– Think about gastric protection, renal impairment, CV, bleeding risk, asthma
What dose would you use for codeine?
Codeine
– 15mg QDS up to maximum of 60mg QDS (24 mg of morphine/day)
– PLUS Laxative senna 7.5-15 mg BD
PRN morphine 2.5-5 mg 2-4 hrs
If N/V haloperidol 0.5-1.5 mg PO (SC if vomiting)
What dose would you use for morphine sulphate immediate release (oromorph)?
Morphine sulphate
– 5-10mg every 4 hr starting dose (10-20 mg if moving from step 2 to 3 WHO) during day.
– 10 mg/ 5ml
– double dose at night
– Usually after WHO step 2 opioid analgesic but if opioid naïve 2.5mg immed/rel starting dose PRN up to hourly
– once stable on 4 hrly doses can change to 12 hrly MST (morphine slow release tablet)
– PRN = 1/6 daily dose of long acting for breakthrough pain
– take care if patient has renal failure
What are the different types of morphine sulphate?
Morphine sulphate immediate release e.g.“Oramorph”
• Onset: ½ hour,
• lasts: 4 hours
• Liquid (does come in tablets – Sevredol)
Morphine sulphate modified release e.g. “Zomorph”
• Onset: 2-6 hours,
• lasts: 12 hours (regular twice daily dosing)
• Capsules
How do you convert codeine/dihydrocodeine to morphine?
Divide by 10
How do you convert tramadol to morphine?
Divide by 10
How do you convert morphine PO to morphine SC?
Divide by 2
How do you convert morphine PO to oxycodone PO?
Divide by 1.5 (divide by 3, times by 2)
How do you convert oxycodone PO to oxycodone SC?
Divide by 1.5 (divide by 3, times by 2)
How do you convert morphine PO to fentanyl patch?
morphine in mg/24hrs divided by 3 to get fentanyl patch ug/hr
Conversion ratio morphine:fentanyl 100:1
Which drugs can reduce peripheral sensitisation?
corticosteriods
NSAIDS
Which drugs reduce pain by blocking sodium channel conduction?
carbamazepine
lidocaine
mexiletine
Which drugs reduce pain by blocking calcium channel conduction?
gabapentin
pregabalin
ziconotide
Which drugs reduce pain by enhancing descending inhibition?
nefopam
antidepressants
tapentadol
tramadol
Which drugs reduce pain by reducing central prostaglandin transmission?
NSAIDs
paracetamol
corticosteroids
Which drugs reduce pain by reducing central sensitisation?
ketamine
methadone
magnesium
Which drugs can reduce pain due to cancer related oedema?
corticosteroids
Which drugs can reduce malignant bone pain?
bisphosphonates
Which drugs can reduce pain from skeletal muscle spasms?
baclofen
benzodiazepines
Which drugs can reduce pain from smooth muscle spasms?
antimuscarinics (e.g Hyoscine butylbromide)
nifedipine
nitrates
When is a syringe driver indicated?
- persistent N & V
- dysphagia
- bowel obstruction
- coma
- patient preference
What proportion of people over 80 yrs experience a fall each year?
up to 50%
What’s the prognosis following a hip fracture?
- only 50% of patients return home
- 30% will die as a consequence
By what mechanisms do drugs cause falls?
- sedation
- hypotension
- bradycardia
What blood pressure is associated with an increase risk of falls?
less than 110 mmHg systolic or lower in old people
When do ACEi and B blockers have a survival benefit?
When someone has systolic cardiac failure. Most old people have diastolic failure.
How do antidepressants and antipsychotics cause falls?
orthostatic hypotension
Which score assesses ADL?
Barthel index
Feeding Bathing Grooming Dressing Bowels Bladder Toilet use Transfers
What are the 5 geriatric giants?
Immobility Instability Incontinence Impaired mental state Iatrogenic- polypharmacy
What score do you use to assess delirium? What is the criteria?
CAM confusion assessment method
Need 1 and 2 and one of 3 and 4
- Acute/fluctuating: change from baseline
- Inattention: can’t keep track of what’s being said
- Disorganised thinking: speech rambling/incoherent/illogical
- Altered consciousness: lethargy/hyper-alert
What are the risk factors for delirium?
Severe illness Urinary retention New environment Dementia/previous delirium Old age Writhing in pain Neuropsych condition previously Ears/eyes Rx anti-ACh, poly pharmacy Sleep deprivation/surgery
Which drugs can cause anorexia?
PPPD SCSC LLIFT Me Now
Phenytoin PPIs Potassium supplements Digoxin SSRIs CCBs Spironolactone Chemo Lithium Levodopa Ipratropium Furosemide Theophylline Metronidazole Narcotics
Which drugs affect taste and smell?
DEAN’s a Happy Person
Dexamethasone Enalapril Amitriptyline Nifedipine Hydromorphine Phenytoin
What is used to screen for malnutrition?
MUST score (malnutrition universal screening tool)
Weightloss
Illness >5 days
BMI
Which drugs increase warfarin effect?
SOFA DEVICE
Sulphonamides
Omeprazole/cimetidine
Fluconazole/ketoconazole/metronidazole
Allopurinol/amiodarone
Disulfiram Ethanol (acute intoxication) Valproate Isoniazid Ciprofloxacin/clarithromycin Erythromycin
Grapefruit juice
Which drugs decrease the effect of warfarin?
P CARBS
Phenytoin Carbamazepine Alcohol Rifampicin Barbiturates Sulphonylureas
What can cause oesophageal erosions?
Alendronate
Erythromycin + ? can cause rhabdomyolysis?
Statin
Which drugs can cause SIADH?
Thiazides
TCAs
Cyclophosphamide
Carbamazepines
What scores are used to assess risk of pressure scores?
Braden score (higher=better) Waterlow score
