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Geriatrics > Lecture 6 > Flashcards

Lecture 6 Flashcards

1
Q

Define multimorbidity and comorbidity.

A
  • Multi = co-occurrence of 2+ chronic medical or psychiatric conditions that may or may not directly interact with each other.
  • Comorbidity = condition or conditions that coexist in the context of a defined disease or condition.

Comorbidity would be like heart disease and hyperlipidemia.

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2
Q

What is a concern with geriatric patients and their multimorbidities?

A

They cannot participate in clinical trials.

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3
Q

What are the 3 AGS action steps for multimorbidity?

A
  1. Identify and comunicate priorities/trajectory
  2. Stop, start, or continue care based on priorities
  3. Align decisions and care among pts, caregivers, and other clinicians.
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4
Q

At what life expectancy should you follow chronic condition actions steps instead of disease-specific guidelines?

A

Life expectancy of 2-10yrs.

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5
Q

AGS Algorithim from UTD for eval and management of the older patient with multimorbidity

A

She said there will be an exam Q on this

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6
Q

What are the common chronic conditions in geriatric patients? (8)

A
  • Urinary incontinence
  • Constipation and fecal incontinence
  • BPH
  • Sleep disorders
  • Sexual dysfunction
  • Osteoporosis
  • DM
  • Weight Loss
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7
Q

What is urinary incontinence?

A

Involuntary loss of urine

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8
Q

What 3 bladder changes occur that lead to urinary incontinence?

A
  • Decline in bladder capacity
  • Increase in residual urine
  • Increase in involuntary bladder contractions

In women:
Diminished estrogen + laxity of pelvic floor muscles

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9
Q

What are the 4 types of urinary incontinence?

A
  • Overflow
  • Stress
  • Urge
  • Functional
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10
Q

What is the mnemonic for reversible urinary incontinence condition?

A
  • Delirium
  • Restricted mobility, retention
  • Infection, inflammation, impaction
  • Polyuria, pharmaceuticals

DRIP

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11
Q

What are some behavioral modifications for urinary incontinence?

A
  • Toileting after meals
  • Scheduled voiding every 2 hours/prompted voiding
  • Frequent inquiries about the need to pass urine.
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12
Q

What is 1st-line, 2nd, and 3rd for urinary incontinence?

A
  1. Exercise, lifestyle, behavior (conservative)
  2. Medications + 1st
  3. Noninvasive office-based acupuncture-like stimulation.
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13
Q

What medications help with urinary incontinence?

A
  • Antimuscarinics: oxybutynin/tolterodine
  • Beta-3 agonists: mirabegron, vibegron

Mainly know the drug classes and their MOA

Caution in glaucoma for antimuscarinics

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14
Q

How many bowel movements is considered normal?

A

At least 3 BMs a week.

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15
Q

What is the correct pooping position?

A
  • Knees higher than hips
  • Lean forward, elbows on knees
  • Bulge out abdomen
  • Straighten spine
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16
Q

What medications are used for BPH?

A
  • Alpha-adrenergic blockers: doxazosin, tamsulosin, terazosin, etc
  • 5-alpha reductase inhibitors: finasteride, dutasteride (use if pt has ED)
17
Q

If BPH is persistent even with meds, what should we suggest?

A

Surgical intervention like a TURP.

18
Q

What are the preferred meds for sleep disorders?

All the bolded ones

A
19
Q

What lubricant types are recommended for hypoestrogenism after menopause?

A

Silicone or water-based only.

20
Q

What deficiency results in osteoporosis usually?

A

Vit D deficiency

21
Q

What is the difference between primary and secondary osteoporosis?

A
  • Primary: Bone loss with normal aging
  • Secondary: caused by Vit D deficiency usually
22
Q

What T-score on a DEXA scan is bad?

A

Anything below -1.0 (aka -2.5) is generally poor.

Below -2.5 is osteoporosis

23
Q

What is the gold standard test for osteoporosis?

A

DEXA Scan

T score -2.5 or lower is osteoporosis.

24
Q

What assessment tool is recommended to screen for fractures?

A

FRAX

25
Q

How do we manage osteoporosis?

A
  • Antiresorptive meds: bisphosphonates, HRT, selective estrogen receptor modulators, denosuman, calcitonin
  • Anabolic meds: Parathyroid hormone
26
Q

Weight Loss Algorithm

SHE SAID TO STAR

A
27
Q

What is failure to thrive an interaction between?

A
  • Physical frailty
  • Disability
  • Impaired neuropsychiatric function
  • Inability to obtain foodstuffs
28
Q

What is optimal BMI in an older adult?

A

24-29

29
Q

What are the aspects of frailty?

A
  • Weight loss
  • Exhaustion
  • Weakness
  • Slow gait
  • Decreased physical activity

Geriatrics (14 decks)

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