Medicine for the Elderly Flashcards
Problems resulting from constipation (4)
Overflow diarrhoea
Urinary retention
Delirium
Abdominal pain/nausea and vomiting
Examples of Osmotic Laxatives
Laxido - prepared in solution
Lactulose
Examples of Stimulant Laxatives
Senna
Biscodyl
Examples of Softener Laxatives
Docusate
Examples of PR solutions
Glycerine suppositories
Microenemas
Phosphate enemas
Groups of Drugs Causing Constipation (2)
Opiates
Anti-Cholinergics
Including Anti-Muscarinics, Anti-Psychotics and Sedating Anti-Histamines
Examples of Bulk Forming Agents
Husk
Have both stimulant and softening actions
Pain Medications avoided in MFE
NSAIDs - GI ulceration
Dihydrocodeine, tramadol - tramadol can cause dizziness
Side Effects of Anti-Cholinergics (6)
Agitation Blurred Vision Constipation Confusion Dry Mouth Stasis of urine/inability to sweat
Examples of Anti-Cholinergics
Anti-Depressants - amitriptyline, imipramine
Anti-Psychotics - clozapine, quetiapine, risperidone, haloperidol
Anti-Emetics - metoclopramide, prochlorperazine
Anti-Spasmodics - oxybutynin
Anti-Allergic - cetirizine, loratadine
Anti-Parkinson’s Drugs - levodopa, procyclidine
Signs in Opioid Toxicity (3)
Jerking/twitching movements
Vivid hallucinations
Sedation (less specific)
If need to switch from morphine, what would be the next opioid choice?
Oxycodone
Managing Breathlessness at End of Life
Non-Pharmacological - breathing exercises, physiotherapy, relaxation
Pharmacological - oral low dose opioid, lorazepam (helps anxiety around SOB), long term oxygen
Contraindications to using laxatives (5)
Intestinal obstruction or perforation Paralytic ileus Faecal impaction IBD Toxic megacolon
How do bulk forming laxatives work?
Contain fibre, act by keeping fluid in the stool to produce distension
How do osmotic laxatives work?
Increasing the amount of fluid in the large bowel producing distension
How do stimulant laxatives work?
Causes peristalsis by stimulating colonic nerves
Biscodyl also stimulates rectal nerves
Lactulose is also helpful in what other condition?
Hepatic encephalopathy
Causes of post-operative hypoxia (4)
Infection
Pulmonary Embolism
Post-operative MI
Pulmonary Oedema
Causes of hypothermia (2)
Long lie
Sepsis - worse prognosis as suggests derangement of physiology
Causes of post-operative tachycardia
Infection
Pulmonary Embolism
Atrial Fibrillation
What is overflow incontinence?
Management
Unable to fully empty the bladder which causes frequent leaking
Ix: bladder scanning and urology referral
Mx: relieve obstruction, instruct individuals in self catheterisation
Investigations (and justification) in Falls
Bloods - FBC = anaemia - U&Es = electrolyte imbalance - LFTs = alcohol - TFTs - B12 = peripheral neuropathy, cognitive - RBG = hypo or hyperglycaemia ECG Echo Visual Assessment Appropriate X-Rays
Osteoporosis and T-score
<2.5 = osteoporosis 1.5-2.5 = osteopenia
Side Effects of Bisphosphonates
Gastritis/GORD symptoms
Osteonecrosis (of jaw)
eGFR consideration bisphosphonates
<35 should NOT be given
Criteria for CT in Acute Confusion (5)
Focal neurological signs Anti-coagulation therapy History of recent falls Head injury Reduced level of consciousness
1st Pharmacological Intervention in Delirium
Haloperidol
Other options in delirium
Can use benzodiazepines if alcohol withdrawal is causing the delirium
Can also be used in Parkinson’s Disease
May worsen the delirium
Electrolyte Disturbance caused by steroids
Hypokalaemia
Presentation of Heart Failure - elderly
Often fatigue dominates
Reduced exercise tolerance + other ‘classical’ features
Management of rate in AF
Digoxin 250mg
Can also use bisoprolol
Transudate pleural effusion
Causes
<30
Causes: cardiac failure, hypoalbuminaemia, nephrotic syndrome
Exudate pleural effusion
Causes
> 30
Causes: malignancy, empyema
