MFE Flashcards
what is sarcopenia and how is it diagnosed
Age related loss of muscle mass, strength and quality
Leads to decline in function
Diagnosed by having low muscle mass and / or low muscle strenghth
what is frailty
Loss of homeostasis and resilience - increased vulnerability after stressor event
Increased risk of falls, delirium or death
frailty scoring test?
rockwood frailty score
features of delirium
Agitation
restless (hyperactive)
Slow,
sleepy (hypoactive)
Fluctuating emotions
Impaired attention
delirium screening tool
4AT
alertness
AMT4- age, d.o.c, where they are, year it is
attention
acute change of fluctuating course
each section as a scoring range from 0-4
4 greater than or equal is consideration for delirium
should be done in every patient over 65 coming into hospital
what bundle is used to treat delerium
TIME bundle
TRIGGERS,
INVESTIAGTE
MANAGE
EXPLAIN
what drugs do you never stop a patient on without consultation
Parkinson drugs
How to manage agitation
Start with non-pharm methods
support, advice, fix underlying problem, one to one monitoring,ect
Pharm methods
haloperidol 500 mcg oral if not possible due to them fighting you phone for help then then IM
Lorazepam 500mcg orally if LBD or Parkinsons
Benzos for alcohol withdrawl
what act must you get for adult with incapacity that refuses treatment
Complete AWI act
what does delirium increase risk of
dementia
what are common drug culprits in causing falls
basically anything that can cause low bp, antcholinergic symptoms or seditives
Diuretics
Anti-hypertensives
Sedatives
Anti-cholinergics
Hypoglycaemic agents
Treatment for postural hypotension
conservative measures
compression stockings
walking aids
medical management
Fludrocortisone
midodrine
what is carotid sinus syndrome
CSH is an overreaction of the carotid sinus reflex, which can be triggered by any pressure on the artery, including wearing tight clothing around the neck or even turning the head and commonly while shaving. This can lead to syncope
Dilation of internal carotid artery that contains loads of baroreceptors
Increased pressure in vessel walls which leads to peripheral vasodilation and reduce heart rate
Basically slight pressure on these receptors can lead to vasodilation and a rapid drop in heart leading to a large change in blood pressure, meaning less blood to the brain and the result is fainting, many times though the patient does not lose conscious when this happens
how is carotid sinus syndrome diagnosed
patient udergoes massage of the carotid sinus for ≥ 3-second pause which in turn causes decrease in systolic BP (≥ 50 mm Hg)
meds used for palliative care
distress- Midazolam 2mg SCUT hourly
nausea- levomepromazine 2.5mg scut every 12 hours
resp secretions- Buscopan 20mg scut hourly
pain- morphine 2mg scut hourly
only give each one if they are experiencing the specific symptoms
example of anti-cholinergic side effects
Short term: confusion and hallucinations, tachycardia, blurred vision, urinary retention, constipation, dizziness
Long term: increase dementia risk
what cant you give for an enlarged prostate when they are on anti-hypertensive medication
alpha blocker + antihypertensive can increase risk of falls by reducing blood pressure too much
what can interfere with the absorption of lithium
calcium
what prescribing tools can be used in elderly medicine
STOPP- stop certain meds
START- start meds
basically stop everything not essential
urge incontenence management
Non parma for 3 months – bladder retraining
pharm-
tolterodine (immediate release) or solfenicin (once daily preparation)
mirabegron- may be useful if there is concern about anticholinergic side-effects in frail elderly patients
what must you ask during urinary incontinence history
faecal incontinence
Why is it important to do a PV exam in incontinent women?
Incase there is big prolapse or incase they really dry and could do with topical oestrogen
What investigations do you do in incontinence investigations
Post void bladder scan
Bladder Diaries
Consider PSA, U&Es, glucose
Urodynamic studies - Not before starting conservative management
Consider before surgery / failure of Rx
what is the comprehensive geriatric assessment(CGA) used for
Multidimensional interdisciplinary diagnostic process focused on determining a frail older person’s medical, psychological and functional capability in order to develop a co-ordinated and integrated plan for treatment and long-term follow-up
what are the 3 components of a comprehensive geriatric assessment(CGA)
Medical-
existing conditions
Co-morbid diseases
Meds
Nutrition
Psychological-
Mental status/ cognition
mood / depression
Functional capacity-
basic ADL (activity of daily living) Extended ADL
Activity/ exercise status
Gait+balance
what is senescence
Senescence is gradual deterioration of function due to defective apoptotic pathway, resulting in non-functioning cells taking up space
why do acidic drugs decrease in absorption as we get older
gatric pH increases causing the stomach to become more alkaline
acidic drugs need acidic pH for absorption (<7.35)
acidic drug examples
penicillin, phenytoin, aspirin
what binds to acidic drugs
albumin
basic drug examples
diazepam, morphine
what binds to basic drugs
A1-AG
why do elderly have a higher volume of distributionfor lipophilic drugs
due to increase in fat they gain
what can grapefruit juice + statins cause
myalgia
what can cranberry juice cause
high INR
what is the therapeutic index
minimum toxic concentration/ minimum effective dose
