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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
Tolterodine is for what?
Anti cholenergic, for urinary problems, but can put intoreyention. Also as ant cholinergic can cause confusion etc
26
What do you need to do differently when taking bloods for calcium?
Do not use a tourniquet
27
Hallucinations in delirium vs Schizophrenia
Delirium = visual - ask re vivid dreams Schizophrenia = auditory
28
Sertraline - hyponatrainia - Hypercalcaemia - Pain - These can all trigger what event?
Delerium
29
Can sedative/hypnotic withdrawal cause delerium?
Yes
30
Innatention dementia vs delerium
Delerium has innattention Tap pen and will get distracted when counting the months backwards
31
What simple question can we use to screen for delerium?
Do you think this patient is more confused today than yesterday?
32
carphologia is what? What is it indicative of?
Lint picking, indicative of delerium
33
Where is it important for us to get a history from in delerium?
Collateral
34
If needed to sedate… due to msssice agitation
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
Causes of delerium
PINCH ME Pain Infection Nutrition Constipation Hydration Medication Environment
36
How can we decide what meds. to stop or start in delerium?
STOPP or START (documents telling you what to stop or start when)
37
Delerium, what tools can you use?
TIME bundle, 4AT
38
Screening test for hyperaldoseteronism
Aldosterone renin ratio
39
Addisons tests
Short synacten Plasma acth
40
Other causes of hypoaldosteronism
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
Electrolyte disturbances in Addisons?
Hyponatraemia Hyperkalaemia Hypoglycaemia Hypercalcaemia
42
Short synacten test results in primary and secondary
Abnormal in both because adrenals atrophy in secondary too
43
Where do check for hyperpigmentation
Where things rub
44
Why do we have low sodium and normal potassium in secondary hypoadrenalism
High levels of vasopressin look up!!!
45
Addisons treatment
Hydrocortisone and fludrocotisone (aldosterone replacement)
46
Which steroids gp cross the placenta
Dexamethasone does Hydrocortisone doesn’t. Hydrocortisone is cortisol
47
Main causes of Hypercalcaemia Blood test to do
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
Investigations of hyperparathyroidism
Seats mibi Parathyroid ultrasound
49
Phaeochrimicytoma
Urinary metenepharines 24h (breakdown products of epinephrine)
50
5HIAA test is for what
Carcinoid syndrome
51
Further tests for phaeochrimocytoma
CT/MRI MIBG functional nuclear scan
52
Pituitary Pancreatic Neuro endocrine **Hyper Parathyroid adenomas **
MEN 1
53
Young brain haemorrhage could be due to what
If they have had a tumour and
54
Men 2
RET Proto oncogene
55
Men 2
RET Proto oncogene
56
Why do you give Alpha blockers and then beta blocker in; phaeochro,ocytomas ?
B2 receptors cause peripheral vasodilation. Therefore beta blockers cause vasoconstriction Ohaeochromocytomas Cause increase adrenalin, works on alpha receptors also causing vasoconstrictions Check !!!
57
MEN 1 AND 2 GENETIC INHERITANCE
Dominant MEN 2 PROPHYLACTIC THYROIDECTOCMY (CHECK) MTC CALCITONIN = TUMOUR MARKER
58
10% tumour
-familial -malignant -bilateral -extra adrenal (paraganglioma) -childhood Ohaeochrimocytomas
59
Classical phaeochromocytoma presentations
Palp Pain (headache) Perspiration Pallor Pressure (bp), paroxysmal
60
What don’t we give for a hypo in renal failure .
Fruit juice (high potassium content )
61
Rules for stopping driving following a hypo
More than one hypoglycaemic episode whilst awake in 12 months
62
What is dawn phenomenon and how is it best addressed?
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
Do we test calcium in confusion
YES ESPECIALLY IN CANCER
64
When would you want to do arterial blood gas rather than vein
For oxygenation and co2 so checking for ventilation issues (needing arterial oxygen sats)
65
Carbocistine is what
Mucolytics thicken up eg pulmonary fibrosis
66
Tamsulosin moa and side effect
Alpha blocker Postural hypotension
67
Amlodapine side effect
Ankle swelling
68
Amytriptiline
Anticholinergic Tca
69
What can we give instead of co codamol?
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
What do we need to prescribe with opioids ?
LACITIVES
71
Where can alk phos come from
Liver !! Bones, so if raised with a raised calcium then we need to think about CANCER esp metastatses to bones Placenta
72
How do we lower calcium?
1. Fluids 3L in 24hours saline 2. If caused by cancer can then use bisphosohanate
73
Older patients what is it crucial to check ? Should be documented
Bladder and bowels!!!
74
What is the SPICT tool?
Supportive and palliative care tool Can use to assess if patient could benefit from anticipatory care plan
75
Advanced directive/advanced decisions/living wills what are they
Comes into place when patient loses capacity. Can only state things about refusing treatment Not legally binding
76
How can we initiate anticipatory care planning?
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
Is it important to tell families that the patient is sick enough to die? That they might not pull through.
Yes
78
What is anticipatory care?
Conversation - needs to be proactive, individualised and should be documented, - see KIS, communicated etc

A - Placement (19 decks)

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