Intro Flashcards
What makes a Px frail?
-increased vulnerability
-decline (age related) in functional + psychological reserve
-Acopia (unable to cope) to everyday stressors
What are the 5 gerries GIANTS?
Iatrogenesis
Immobility
Instability + inanition (poor nutrition)
Intellectual impairment
Incontinence
What are the 5 gerries M’s?
-Mind (maintaining mental activity)
-Mobility (help walk and prevent falls)
-Medications (reduce poly pharmacy)
-Multicomplexity (multiple conditions)
-Matters most (advanced care planning)
What roles are in the MDT?
MFPSE
Medical
Functional
Psych
Social
Environmental
Who is involved in the medical side of MDTs?
what do they discuss/assess?
Dr, Nurse, Pharmacist, Dietician
pMHx, Drug Hx, nutrition
Who is involved in the functional side of MDTs?
what do they discuss/assess?
OT, PT, SALT
ADL’s, frailty
Who is involved in the Psych side of MDTs?
what do they discuss/assess?
Dr, psychiatry, Nurse
GCS, 4AT (AMS?), PHQ-9
Who is involved in the social side of MDTs?
what do they discuss/assess?
OT, social worker
reintegration post DC
Who is involved in the environmental side of MDTs?
what do they discuss/assess?
community nurse, NHS appointed house assessor eg. social worker
What is poly pharmacy?
5+ meds concurrently
what is pharmacokinetics?
body effect on drug (ADME)
What is pharmacodynamics?
drugs effect on body
What is appropriate and inappropriate poly pharmacy?
Appropriate = 5+ meds and needed eg. MI prophylaxis
Inappropriate = Lots of unnecessary meds - sequential prescribing, high co morbidities, pain Hx
What does anticholinergic burden (ACB) mean?
Taking multiple drugs with anticholinergic effects creates an anticholinergic burden
What score is high in ACB and what Sx does it cause in elderly?
3 or more
Causes increased falls, AMS + Morbidity in elderly (>65) - 70% chance adverse effect
Ach syndrome, how does it affect the PNS + CNS?
PNS = Can’t SEE, PEE, SPIT, SHIT + flushing
CNS = Agitation, low GCS, AMS, Ataxia
What are some examples of ACB 1?
codeine, prednisolone, warfarin
What are some examples of ACB 3?
Paroxetine, amitryptilline, clozapine, promethazine, quetiapine, oxybutynin
What 2 medications interact with warfarin? what do they cause?
warfarin + NSAIDS = increase bleed risk
Warfarin + macrolide (erythromycin, clarythromycin) / metronidazole = Increases INR
What does omeprazole interact with to cause?
Omeprazole + clopidogrel = low clopidogrel effect
what do SSRIs interact with to cause?
SSRI + NSAIDs = high GI bleed risk = co prescribe PPI
what do ACE-i interact with to cause?
ACE-i + spironolactone = high AKI risk + High K+
What does methotrexate interact with to cause?
Methotrexate + trimethoprim = myelosuppression
what 2 meds/other do statins interact with to cause?
statin + macrolide
statin + grapefruit juice
When was the mental capacity act instated and what does it do?
MCA 2005
Empowers 16 and over decision making in lacked capacity
what does Fe interact with to cause?
Fe + tetracycline (reduce tetracycline effect)
what principles are upheld in the mental capacity act?
impaired brain? enough to lack capacity?
Principles: Best interests, assume capacity till otherwise proved, no harm principle, Give all info, least restrictive option
What does IMCA stand for?
What are they and what do they do?
Independent mental capacity advocate
NHS appointed for non LPA Px
Can inquire medical decisions but cannot make decisions on patients behalf
LPA:
What is it?
What are the 2 types?
what can they do?
Lasting power of attorney
Appointed by Px to make decisions on their behalf if lack capacity
Financial + health (regulated with office of pub guard)
What is an Advanced Directive?
written statement by 18+ detailing Tx preferences should they lack capacity in future
Applicable to situation, CAN’T demand Tx (only refuse) and CAN’T refuse basic Tx (food, hydration)
what is a Court appointed decision (CAD)?
No LPA + dispute over best interests - apply to court for temp decision maker
What does DoLs stand for?
deprivation of liberty safeguards
What does DoLs do?
Principles?
Px unfree to leave 24hr supervised residence for 7 or less days if pose risk to self or others
least restrictive option, Px lacks capacity, can do <12m total
Principles: best interests, pose risk to self, deprivation-risk of harm is proportionate
If a Px with capacity is wanting to self discharge, what 4 pieces of info is needed?
- Drug Hx update
- OT
- PT
- GP f/u and letter to GP
