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Phase 3a Geriatrics > Intro > Flashcards

Intro Flashcards

1
Q

What makes a Px frail?

A

-increased vulnerability
-decline (age related) in functional + psychological reserve
-Acopia (unable to cope) to everyday stressors

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2
Q

What are the 5 gerries GIANTS?

A

Iatrogenesis
Immobility
Instability + inanition (poor nutrition)
Intellectual impairment
Incontinence

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3
Q

What are the 5 gerries M’s?

A

-Mind (maintaining mental activity)
-Mobility (help walk and prevent falls)
-Medications (reduce poly pharmacy)
-Multicomplexity (multiple conditions)
-Matters most (advanced care planning)

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4
Q

What roles are in the MDT?

A

MFPSE
Medical
Functional
Psych
Social
Environmental

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5
Q

Who is involved in the medical side of MDTs?
what do they discuss/assess?

A

Dr, Nurse, Pharmacist, Dietician
pMHx, Drug Hx, nutrition

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6
Q

Who is involved in the functional side of MDTs?
what do they discuss/assess?

A

OT, PT, SALT
ADL’s, frailty

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7
Q

Who is involved in the Psych side of MDTs?
what do they discuss/assess?

A

Dr, psychiatry, Nurse
GCS, 4AT (AMS?), PHQ-9

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8
Q

Who is involved in the social side of MDTs?
what do they discuss/assess?

A

OT, social worker
reintegration post DC

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9
Q

Who is involved in the environmental side of MDTs?
what do they discuss/assess?

A

community nurse, NHS appointed house assessor eg. social worker

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10
Q

What is poly pharmacy?

A

5+ meds concurrently

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11
Q

what is pharmacokinetics?

A

body effect on drug (ADME)

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12
Q

What is pharmacodynamics?

A

drugs effect on body

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13
Q

What is appropriate and inappropriate poly pharmacy?

A

Appropriate = 5+ meds and needed eg. MI prophylaxis

Inappropriate = Lots of unnecessary meds - sequential prescribing, high co morbidities, pain Hx

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14
Q

What does anticholinergic burden (ACB) mean?

A

Taking multiple drugs with anticholinergic effects creates an anticholinergic burden

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15
Q

What score is high in ACB and what Sx does it cause in elderly?

A

3 or more
Causes increased falls, AMS + Morbidity in elderly (>65) - 70% chance adverse effect

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16
Q

Ach syndrome, how does it affect the PNS + CNS?

A

PNS = Can’t SEE, PEE, SPIT, SHIT + flushing

CNS = Agitation, low GCS, AMS, Ataxia

17
Q

What are some examples of ACB 1?

A

codeine, prednisolone, warfarin

18
Q

What are some examples of ACB 3?

A

Paroxetine, amitryptilline, clozapine, promethazine, quetiapine, oxybutynin

19
Q

What 2 medications interact with warfarin? what do they cause?

A

warfarin + NSAIDS = increase bleed risk

Warfarin + macrolide (erythromycin, clarythromycin) / metronidazole = Increases INR

20
Q

What does omeprazole interact with to cause?

A

Omeprazole + clopidogrel = low clopidogrel effect

21
Q

what do SSRIs interact with to cause?

A

SSRI + NSAIDs = high GI bleed risk = co prescribe PPI

22
Q

what do ACE-i interact with to cause?

A

ACE-i + spironolactone = high AKI risk + High K+

23
Q

What does methotrexate interact with to cause?

A

Methotrexate + trimethoprim = myelosuppression

24
Q

what 2 meds/other do statins interact with to cause?

A

statin + macrolide
statin + grapefruit juice

25
Q

When was the mental capacity act instated and what does it do?

A

MCA 2005
Empowers 16 and over decision making in lacked capacity

26
Q

what does Fe interact with to cause?

A

Fe + tetracycline (reduce tetracycline effect)

27
Q

what principles are upheld in the mental capacity act?

A

impaired brain? enough to lack capacity?

Principles: Best interests, assume capacity till otherwise proved, no harm principle, Give all info, least restrictive option

28
Q

What does IMCA stand for?
What are they and what do they do?

A

Independent mental capacity advocate

NHS appointed for non LPA Px
Can inquire medical decisions but cannot make decisions on patients behalf

29
Q

LPA:
What is it?
What are the 2 types?
what can they do?

A

Lasting power of attorney

Appointed by Px to make decisions on their behalf if lack capacity

Financial + health (regulated with office of pub guard)

30
Q

What is an Advanced Directive?

A

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)

31
Q

what is a Court appointed decision (CAD)?

A

No LPA + dispute over best interests - apply to court for temp decision maker

32
Q

What does DoLs stand for?

A

deprivation of liberty safeguards

33
Q

What does DoLs do?
Principles?

A

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

34
Q

If a Px with capacity is wanting to self discharge, what 4 pieces of info is needed?

A
  1. Drug Hx update
  2. OT
  3. PT
  4. GP f/u and letter to GP

Phase 3a Geriatrics (5 decks)

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