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Quesmed phase 3a > gerries > Flashcards

gerries Flashcards

1
Q

what drug can you add in to 1st line treatment for Alzheimers that continues to progress?
Drug and class

A

memantine
NMDA receptor antagonist

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2
Q

BP change for a diagnosis of postural hyoptention

A
  • a fall of 20mmHg or more in systolic blood pressure, OR
  • a fall of 10mmHg or more in diastolic pressure.
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3
Q

postural hypotension Mx

A
  • 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
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4
Q

what is pseudo-dementia

A

cognitive deficits seen in elderly pts with depression

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5
Q

pseudo dementia mx

A

manage the underlying depression with drugs and CBT

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6
Q

options for sedation of pts with delirium

A
  • haloperidol [PO or IM]
  • lorazepam IM
  • olanzapine - use with caution in elderly pts due to risk of SEs.
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7
Q

why might a subdural haemorrhage have a delayed presentation

A

subdural haemorrhage involves the bridging veins rather an artery ∴ there is lower pressure and blood accumulates slower.

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8
Q

what is an advanced decision

A
  • 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.
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9
Q

what is an advanced statement

A
  • “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
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10
Q

what can an advanced decision cover

A
  • 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
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11
Q

what anti-emetic is given in parkinsons + why

A

domperidone as it doesn’t cross the BBB

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12
Q

what is the first line drug for sedation in delirium and why

A
  • 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.
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13
Q

key feature of dewy body dementia

A
  • fluctuating attention and concentration
  • visual hallucinations
  • spontaneous Parkinsonism
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14
Q

side effect of trimethoprim related to blood

A

megaloblastic anaemia + ↑ eGFR.
because trimethoprim affects folate metabolism, it can –> megaloblastic anaemia which can in turn affect eGFR by ↑ creatinine levels

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15
Q

which diuretic is most likely to cause dehydration and reduced intravascular volume

A

furosemide
a potent loop diuretic

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16
Q

name some seizure threshold lowering drugs

A
  • Antibiotics: Imipenem, penicillins, cephalosporins, metronidazole, ciproflocain, isoniazid
  • Antipsychotics
  • Antidepressents: Bupropion, Tricyclics, Venlafaxine
  • Tramadol
  • Fentanyl
  • Ketamine
  • Lidocaine
  • Lithium
  • Antihistamines
17
Q

what is benserazide

A

Benserazide is a decarboxylase inhibitor which prevents the peripheral breakdown of levodopa. This means that levodopa is decarboxylated into dopamine in the brain,

18
Q

hypodense Vs hyperdense on CT

A

hypOdense = Old bleed and is dark on CT
hyper dense = acute bleed and is bright on CT

19
Q

timings for acute, sub-acute and chronic subdural haemorrhage

A
  • 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.
20
Q

opioid use in renal failure

A
  • 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.
21
Q

how might vascular dementia show up on an MRI

A

White matter hyperintensities on MRI are commonly associated with vascular dementia as they represent chronic small vessel ischemic changes in the brain.

22
Q

how might Alzheimer’s show up on an MRI

A

generalised atrophy

23
Q

contraindication for memantine

A
  • asthma it may exacerbate airway hyperresponsiveness
  • uncontrolled hypertension due to the risk of hypertensive crises as memantine can increase BP
  • severe renal impairment
24
Q

contraindications for acetylcholinesterase inhibitors

A

Bradycardia is a contraindication as these medications can exacerbate or cause bradycardia by increasing vagal tone, potentially leading to heart block or syncope.

25
Q

what sedative is contraindicated in parkinsons

A

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

26
Q

describe the tremor seen in Parkinson’s

A

Assymetric pill-rolling tremor @ 3-5Hz

27
Q

greatest RF for developing Alzheimers

A

age

28
Q

short term side effect of levodopa

A

abnormal dreams

29
Q

long term side-effects of levodopa

A
  • 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
30
Q

contraindication for sildenafil

A

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

31
Q

midodrine MoA

A

Alpha-1-agonist

32
Q

An advance statement is legally binding
T/F

A

False

33
Q

mnemonic for delirium

A

PINCH ME

34
Q
A

Quesmed phase 3a (6 decks)

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