gerries Flashcards
what drug can you add in to 1st line treatment for Alzheimers that continues to progress?
Drug and class
memantine
NMDA receptor antagonist
BP change for a diagnosis of postural hyoptention
- a fall of 20mmHg or more in systolic blood pressure [at least 30 in HTN]
AND/OR - a fall of 10mmHg or more in diastolic pressure.
- WITHIN 3 MINS
postural hypotension Mx
- ensure adequate hydration
- check polypharmacy to identify medication-related causes
- behavioural changes: standing up slowly from a sitting/ lying position. dorsiflexing the feet first before standing upright.
- drugs: 1st = fludrocortisone 2nd = midodrine
what is pseudo-dementia
cognitive deficits seen in elderly pts with depression
pseudo dementia mx
manage the underlying depression with drugs and CBT
options for sedation of pts with delirium
- haloperidol [PO or IM]
- lorazepam IM
- olanzapine - use with caution in elderly pts due to risk of SEs.
why might a subdural haemorrhage have a delayed presentation
subdural haemorrhage involves the bridging veins rather an artery ∴ there is lower pressure and blood accumulates slower.
what is an advanced decision
- An Advanced Decision, short for Advanced Decision to Refuse Treatment, is a legally binding document.
- Its purpose is to ensure that an individual can refuse a specific treatment(s) that they do not want to have in the future.
what is an advanced statement
- “Statement of Wishes and Care Preferences”.
- It allows an individual to make general statements about their wishes, beliefs, feelings and values and how these influence their preferences for their future care and treatment
what can an advanced decision cover
- refusal of any treatments including life-sustaining ones
- CANNOT refuse basic care including cleaning, food and drink + MH care.
- CANNOT request specific treatment or illegal Tx - euthanasia
what anti-emetic is given in parkinsons + why
domperidone as it doesn’t cross the BBB
what is the first line drug for sedation in delirium and why
- Haloperidol as it has a rapid onset of action + a short half life which makes it easier to titrate and adjust to pt response.
- lorazepam is 2nd line as it has a long half life and can worsen pt confusion.
key feature of lewy body dementia
- fluctuating attention and concentration
- visual hallucinations - Classically, patients complain of seeing small mammals around them
- spontaneous Parkinsonism
side effect of trimethoprim related to blood
megaloblastic anaemia + ↑ eGFR.
because trimethoprim affects folate metabolism, it can –> megaloblastic anaemia which can in turn affect eGFR by ↑ creatinine levels
which diuretic is most likely to cause dehydration and reduced intravascular volume
furosemide
a potent loop diuretic
name some seizure threshold lowering drugs
- Antibiotics: Imipenem, penicillins, cephalosporins, metronidazole, ciproflocain, isoniazid
- Antipsychotics
- Antidepressents: Bupropion, Tricyclics, Venlafaxine
- Tramadol
- Fentanyl
- Ketamine
- Lidocaine
- Lithium
- Antihistamines
what is benserazide
Benserazide is a decarboxylase inhibitor which prevents the peripheral breakdown of levodopa. This means that levodopa is decarboxylated into dopamine in the brain,
hypodense Vs hyperdense on CT
hypOdense = Old bleed and is dark on CT
hyper dense = acute bleed and is bright on CT
timings for acute, sub-acute and chronic subdural haemorrhage
- Acute: develops within 3 days of traumatic incident
- Chronic: >21 days old, slow onset with no obvious cause of symptoms
- Sub-acute 3-21 days old.
opioid use in renal failure
- avoid morphine as it produces metabolites that accumulate in the kidney and further any renal failure
- oxycodone is safe to use in renal failure as it doesn’t produce these metabolites.
how might vascular dementia show up on an MRI
White matter hyperintensities on MRI are commonly associated with vascular dementia as they represent chronic small vessel ischemic changes in the brain.
how might Alzheimer’s show up on an MRI
generalised cortical atrophy
contraindications for memantine
- asthma it may exacerbate airway hyperresponsiveness
- uncontrolled hypertension due to the risk of hypertensive crises as memantine can increase BP
- severe renal impairment
contraindications for acetylcholinesterase inhibitors
Bradycardia is a contraindication as these medications can exacerbate or cause bradycardia by increasing vagal tone, potentially leading to heart block or syncope.
what sedative is contraindicated in parkinsons
Haloperidol is contraindicated in patient’s with Parkinson’s disease due to the fact that it promotes dopamine blockade.
This can result in psychosis and a deterioration in motor function
describe the tremor seen in Parkinson’s
Assymetric pill-rolling tremor @ 3-5Hz
greatest RF for developing Alzheimers
age
short term side effect of levodopa
abnormal dreams
long term side-effects of levodopa
- drug-induced dyskinesia: writhing and uncoordinated movements of the limbs associated with poorly organised dopaminergic control of motor activity
- End of dose deterioration
- Early morning hypokinesia or akinesia
contraindication for sildenafil
Sildenafil is a PDE5 inhibitor and leads to vasodilation of the peripheral vasculature leading to a drop in the blood pressure in a similar way to how nitrates work –> compounded effect that can be life threatening
midodrine MoA
Alpha-1-agonist
An advance statement is legally binding
T/F
False
mnemonic for delirium
PINCH ME
Dx tool for delirium
4AT screening tool is used to detect delirium and CAM is used to confirm it.
4AT:
- Alertness,
- Ask [age, DoB, place, current year],
- Attention [months of the year backwards],
- Acute change or fluctuating course
what is the MUST score
The Malnutrition Universal Screening Tool score helps identify adults who are malnourished or those who are at risk of malnutrition to ensure their needs are being adequately met.
what can be used to assess the overall fitness of an elderly pt
Rockwood frailty scale
- This can be helpful when considering management of a patient during their hospital admission but also for their post-admission package of care
how do you calculate breakthrough pain
Breakthrough pain medication is calculated as a sixth of the total daily dose.
delirium criteria
- Impairment of consciousness and attention 2. Global disturbance in cognition
- Psychomotor disturbance
- Disturbance of sleep-wake cycle
- Emotional disturbances
what is included in a confusion screen
where are pressure ulcers most likely to occur
over bony prominences
What tool is used to estimate a person’s risk of developing a pressure ulcer
Waterlow score
RFs for the development of pressure ulcers
- Surgery.
- Incontinence (faecal or urinary)
- Smoking.
- Immobility and reduced ability to change positions
- Prolonged pressure on specific body areas (e.g., bedridden or wheelchair-bound individuals)
- Poor nutrition and hydration
- Advanced age
- Chronic illnesses and those which impair healing (e.g. diabetes, peripheral vascular disease)
- Reduced sensory perception
complications of pressure sores
cellulitis / abscess formation
sepsis
osteomyelitis
scarring
delayed wound healing
Mx of pressure sores
Regular repositioning.
Pressure reducing aids (e.g. seat cushions, pillows)
Wound cleaning and dressing.
Analgesia for pain (e.g. Paracetamol)
Nutritional assessment.
differences between delirium and dementia
- Onset: Delirium has an acute onset (upto 6m), while dementia is chronic and
progressive (6m+) (1) - Course: Delirium is typically fluctuating, with periods of lucidity; dementia is more
stable over time (1) - Attention: In delirium, there is marked inattention; in dementia, attention is
relatively preserved in early stages
What are the 2 recommended tests from NICE to assess patients at risk of falls
Turn 180 test
Timed Up and Go Test
