Medicine for the Elderly Flashcards
Initial management of postural hypotension
Advise pt to dorsiflex feet or cross legs before standing up slowly
- prevents excessive diuresis and fluid shifts
- pharm management may incl fludrocortisone
Why does constipation cause delirium?
Marked increase in intestinal production and absorption of ammonia which tends to lead to a similar pathophysiology in hepatic encephalopathy
How can a falls inducing syncope best be investigated?
Implantable loop recorder
- likely cardiac cause
Key med not to stop in dementia patients
Paracetamol/analgesia
- proven that paracetamol reduces agitation in dementia patients
Delirium, profound hypoxia, nothing to hear in the chest and normal temp
PE
- old people don’t tend to present in the usual way so may not have breathlessness of chest pain
Calcium causes which symptom in old people
GI upset
- nausea
- abdo pains etc
Stop if they don’t need it and assess for change in GI function
Management non-aggressive delirium with falls risk
1-to-1 nursing
Management of pt with delirium, no PoA, unable to function independently at home, care package failed previously
Apply to courts for guardian
4 key palliative drugs and their doses
Morphine 2mg subcut PRN
Midazolam 2mg hourly subcut PRN
Hyoscine butylbromide injection 20mg PRN
Levomepromazine 2.5 mg injection 8 subcut PRN
Course of symptoms in LBD
FLuctuating
Hx of nausea and vomiting in a pt with IHD and AF, now developed visual changes and dizziness
Digoxin
5 Ps causing delirium
- Pee
- Poo
- Pus
- Pills/poison
- Pain
Confusion screen
B12/folate = macro anaemia can worsen confusion
TFTs = hypothyroidism
Glucose = hypoglycaemia
Bone profile =hypercalcaemia
Which drugs greatly increase mortality in dementia pts?
Antipsychotics
What law means that patient’s rights are protected despite them being detained?
Deprivation of liberty safeguards
Key med contraindicated in concurrent sildenafil use
Nitrates
- causes hypotension, heavy vasodilation, can lead to death
Microcytic anaemia with noooooo symptoms and normal iron studies
Thalassaemia trait
FL pain management in palliative pts with renal impairment
Oxycodone
When would you give each laxative?
- Offer a bulk-forming laxative first-line, such as ispaghula—> making stools softer and easier to pass.
- If stools remain hard to pass, add or switch to an osmotic laxative, such as a macrogol.
- If a macrogol is ineffective or not tolerated, offer treatment with lactulose second-line.
- If stools are soft but difficult to pass, or there is a sensation of inadequate emptying, add a stimulant laxative (Senna).
- If the person has opioid-induced constipation: Offer an osmotic laxative and a stimulant laxative.
First CN to be affected by SOL or raised ICP
CNVI
