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A - Placement > Long Term Conditions > Flashcards

Long Term Conditions Flashcards

1
Q

What are the sick day rule drugs

A

ACEi
ARB
NSAIDS
Diuretics
Metformin

AAND M

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2
Q

AND polyparmacy deadly combo

A

ACEi NSAIDs diuretics

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3
Q

3 things to think about if dose v high

A

Compliance
Working drug ?

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4
Q

What is the surprise question

A

Would I’ve surprised if this patient was dead in the next 6/12 months

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5
Q

What do we want to think about re ward rounds to highlight inappropriate polypharmacy

A

Low bp
Low glucose
Blood too thin
Kidneys too vulnerable

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6
Q

Can anticholinergic drugs lower bp

A

Yes

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7
Q

Gabapentin, citalopram and tamsulosin affects on bp?

A

Lowers

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8
Q

Citralopram adverse affect

A

Long QT syndrome

So we tend to give sertraline

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9
Q

Once you hit 50, what do we NOT prescribe for pain in older people?

A

NSAIDS

OA : do physio - best way to improve pain

(Try non pharmacological or paracetamol )

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10
Q

Analgesic used older hip fracture

A

Oxycodon

Not morphine because it is excreted by the kidneys and so will often cause aki

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11
Q

What is the requirement egfr for met formin?

A

Over 30, really want it over 40. Metformin can also cause gi upset

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12
Q

Older people how do we determine a uti?

A

Mid stream sample of urine

Can’t do a dip as so many types

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13
Q

Post menopausal women recurrent uti alternative causes

A

Estrogen receptors on the bottom of the bladder
Prolapse
Constipation

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14
Q

Amlodapine and simastatin? Do they go?

A

They interact, so can’t only have simvastating 20mg

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15
Q

Side effect of prochlorperazine?

A

Pseudoparkinons

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16
Q

NSAIDs, aspirin and citralopram gi risks

A

GI Bleeding

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17
Q

What is frailty and what are the underlying causes?

A

Loss of reserve leading to exaggerated loss of function due to minor event.

Caused by inflammatory and immune responses

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18
Q

What is sarcopenia?

A

Loss of muscle and strength

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19
Q

What is the phenotype model of frailty?

A
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20
Q

What models are used for frailty in gp/hosp?

A

Hosp: rock wood clinical frailty score
Gp: cumulative frailty score - automatic online based on what was coded for

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21
Q

What assessments do we have for frailty?

A

Gait speed, get up and go, prisma7

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22
Q

What are the frailty syndromes?

A

Falls, incontinence, immobility, delirium, polypharmacy

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23
Q

Why is it so important to do medication reviews for frailty?

A

Patients with frailty chance of drug interactions is 35% as opposed to 5% for those without frailty

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24
Q

What is alendronate ?

A

Bisphoshonate for bones

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25
Q

Tolterodine is for what?

A

Anti cholenergic, for urinary problems, but can put intoreyention. Also as ant cholinergic can cause confusion etc

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26
Q

What do you need to do differently when taking bloods for calcium?

A

Do not use a tourniquet

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27
Q

Hallucinations in delirium vs Schizophrenia

A

Delirium = visual - ask re vivid dreams
Schizophrenia = auditory

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28
Q

Sertraline - hyponatrainia -
Hypercalcaemia -
Pain -

These can all trigger what event?

A

Delerium

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29
Q

Can sedative/hypnotic withdrawal cause delerium?

A

Yes

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30
Q

Innatention dementia vs delerium

A

Delerium has innattention
Tap pen and will get distracted when counting the months backwards

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31
Q

What simple question can we use to screen for delerium?

A

Do you think this patient is more confused today than yesterday?

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32
Q

carphologia is what? What is it indicative of?

A

Lint picking, indicative of delerium

33
Q

Where is it important for us to get a history from in delerium?

A

Collateral

34
Q

If needed to sedate… due to msssice agitation

A

Lorazepam IM 0.5mg esp alcoholism

OR

Haloperidol 1mg - any psychotic symptoms BUT look out for long QT **not in Parkinson’s **

START LOW GO SLOW

35
Q

Causes of delerium

A

PINCH ME

Pain
Infection
Nutrition
Constipation
Hydration

Medication
Environment

36
Q

How can we decide what meds. to stop or start in delerium?

A

STOPP or START (documents telling you what to stop or start when)

37
Q

Delerium, what tools can you use?

A

TIME bundle, 4AT

38
Q

Screening test for hyperaldoseteronism

A

Aldosterone renin ratio

39
Q

Addisons tests

A

Short synacten
Plasma acth

40
Q

Other causes of hypoaldosteronism

A

Waterhouse fried rich syndrome (adrenal haemorrhage)
Bilateral adrenal glands
ConGenital hyperplasia/hypoplasia (hyperplasia, when you don’t have the enzymes so the other products build up and the glands get bigger
TB, HIV
Chaemo therapy (immune checkpoint inhibitor’s)
Autoimmune adrenal it is

41
Q

Electrolyte disturbances in Addisons?

A

Hyponatraemia
Hyperkalaemia
Hypoglycaemia
Hypercalcaemia

42
Q

Short synacten test results in primary and secondary

A

Abnormal in both because adrenals atrophy in secondary too

43
Q

Where do check for hyperpigmentation

A

Where things rub

44
Q

Why do we have low sodium and normal potassium in secondary hypoadrenalism

A

High levels of vasopressin look up!!!

45
Q

Addisons treatment

A

Hydrocortisone and fludrocotisone (aldosterone replacement)

46
Q

Which steroids gp cross the placenta

A

Dexamethasone does

Hydrocortisone doesn’t. Hydrocortisone is cortisol

47
Q

Main causes of Hypercalcaemia

Blood test to do

A

Cancer (and mets) inc. multiple myeloma
Hyperparathyroidism

Other
Drugs (lithupium)
Granulomatous diseases (sarcoidosis, tb)
Severe immobility, pagets disease (mild)
Addisons
Vit D poisoning

Blood test pth

48
Q

Investigations of hyperparathyroidism

A

Seats mibi
Parathyroid ultrasound

49
Q

Phaeochrimicytoma

A

Urinary metenepharines 24h (breakdown products of epinephrine)

50
Q

5HIAA test is for what

A

Carcinoid syndrome

51
Q

Further tests for phaeochrimocytoma

A

CT/MRI
MIBG functional nuclear scan

52
Q

Pituitary
Pancreatic Neuro endocrine
**Hyper Parathyroid adenomas **

A

MEN 1

53
Q

Young brain haemorrhage could be due to what

A

If they have had a tumour and

54
Q

Men 2

A

RET Proto oncogene

55
Q

Men 2

A

RET Proto oncogene

56
Q

Why do you give Alpha blockers and then beta blocker in; phaeochro,ocytomas ?

A

B2 receptors cause peripheral vasodilation.

Therefore beta blockers cause vasoconstriction

Ohaeochromocytomas Cause increase adrenalin, works on alpha receptors also causing vasoconstrictions

Check !!!

57
Q

MEN 1 AND 2 GENETIC INHERITANCE

A

Dominant

MEN 2 PROPHYLACTIC THYROIDECTOCMY (CHECK)

MTC CALCITONIN = TUMOUR MARKER

58
Q

10% tumour

A

-familial
-malignant
-bilateral
-extra adrenal (paraganglioma)
-childhood

Ohaeochrimocytomas

59
Q

Classical phaeochromocytoma presentations

A

Palp
Pain (headache)
Perspiration
Pallor
Pressure (bp), paroxysmal

60
Q

What don’t we give for a hypo in renal failure .

A

Fruit juice (high potassium content )

61
Q

Rules for stopping driving following a hypo

A

More than one hypoglycaemic episode whilst awake in 12 months

62
Q

What is dawn phenomenon and how is it best addressed?

A

Diabetes

Cortisol increasing glucose in the morning

Best managed with insulin pump therapy (short acting insulin that can be changed released hour by hour)

63
Q

Do we test calcium in confusion

A

YES

ESPECIALLY IN CANCER

64
Q

When would you want to do arterial blood gas rather than vein

A

For oxygenation and co2 so checking for ventilation issues (needing arterial oxygen sats)

65
Q

Carbocistine is what

A

Mucolytics thicken up eg pulmonary fibrosis

66
Q

Tamsulosin moa and side effect

A

Alpha blocker
Postural hypotension

67
Q

Amlodapine side effect

A

Ankle swelling

68
Q

Amytriptiline

A

Anticholinergic Tca

69
Q

What can we give instead of co codamol?

A

Paracetamol
Oxycodone (twice as strong as morphine ) fast release, what the orthogeriatricians

If you were to prescribe any form of codine then dihydracodine as generally better absorbed

70
Q

What do we need to prescribe with opioids ?

A

LACITIVES

71
Q

Where can alk phos come from

A

Liver !!

Bones, so if raised with a raised calcium then we need to think about CANCER esp metastatses to bones

Placenta

72
Q

How do we lower calcium?

A
  1. Fluids 3L in 24hours saline
  2. If caused by cancer can then use bisphosohanate
73
Q

Older patients what is it crucial to check ? Should be documented

A

Bladder and bowels!!!

74
Q

What is the SPICT tool?

A

Supportive and palliative care tool

Can use to assess if patient could benefit from anticipatory care plan

75
Q

Advanced directive/advanced decisions/living wills what are they

A

Comes into place when patient loses capacity.

Can only state things about refusing treatment

Not legally binding

76
Q

How can we initiate anticipatory care planning?

A

Have you had a thought about the future?
What are your best hopes? What are your dreads?

Is your goals these days; to live as long as possible or to live as comfortable as possible? Thresholds?

77
Q

Is it important to tell families that the patient is sick enough to die? That they might not pull through.

A

Yes

78
Q

What is anticipatory care?

A

Conversation - needs to be proactive, individualised and should be documented, - see KIS, communicated etc

A - Placement (16 decks)

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