MFE Flashcards

1
Q

what is sarcopenia and how is it diagnosed

A

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

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2
Q

what is frailty

A

Loss of homeostasis and resilience - increased vulnerability after stressor event
Increased risk of falls, delirium or death

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3
Q

frailty scoring test?

A

rockwood frailty score

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4
Q

features of delirium

A

Agitation
restless (hyperactive)
Slow,
sleepy (hypoactive)
Fluctuating emotions
Impaired attention

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5
Q

delirium screening tool

A

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

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6
Q

what bundle is used to treat delerium

A

TIME bundle

TRIGGERS,
INVESTIAGTE
MANAGE
EXPLAIN

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7
Q

what drugs do you never stop a patient on without consultation

A

Parkinson drugs

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8
Q

How to manage agitation

A

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

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9
Q

what act must you get for adult with incapacity that refuses treatment

A

Complete AWI act

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10
Q

what does delirium increase risk of

A

dementia

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11
Q

what are common drug culprits in causing falls

A

basically anything that can cause low bp, antcholinergic symptoms or seditives

Diuretics
Anti-hypertensives
Sedatives
Anti-cholinergics
Hypoglycaemic agents

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12
Q

Treatment for postural hypotension

A

conservative measures
compression stockings
walking aids

medical management
Fludrocortisone
midodrine

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13
Q

what is carotid sinus syndrome

A

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

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14
Q

how is carotid sinus syndrome diagnosed

A

patient udergoes massage of the carotid sinus for ≥ 3-second pause which in turn causes decrease in systolic BP (≥ 50 mm Hg)

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15
Q

meds used for palliative care

A

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

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16
Q

example of anti-cholinergic side effects

A

Short term: confusion and hallucinations, tachycardia, blurred vision, urinary retention, constipation, dizziness

Long term: increase dementia risk

17
Q

what cant you give for an enlarged prostate when they are on anti-hypertensive medication

A

alpha blocker + antihypertensive can increase risk of falls by reducing blood pressure too much

18
Q

what can interfere with the absorption of lithium

A

calcium

19
Q

what prescribing tools can be used in elderly medicine

A

STOPP- stop certain meds

START- start meds

basically stop everything not essential

20
Q

urge incontenence management

A

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

21
Q

what must you ask during urinary incontinence history

A

faecal incontinence

22
Q

Why is it important to do a PV exam in incontinent women?

A

Incase there is big prolapse or incase they really dry and could do with topical oestrogen

23
Q

What investigations do you do in incontinence investigations

A

Post void bladder scan
Bladder Diaries
Consider PSA, U&Es, glucose
Urodynamic studies - Not before starting conservative management
Consider before surgery / failure of Rx

24
Q

what is the comprehensive geriatric assessment(CGA) used for

A

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

25
Q

what are the 3 components of a comprehensive geriatric assessment(CGA)

A

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

26
Q

what is senescence

A

Senescence is gradual deterioration of function due to defective apoptotic pathway, resulting in non-functioning cells taking up space

27
Q

why do acidic drugs decrease in absorption as we get older

A

gatric pH increases causing the stomach to become more alkaline

acidic drugs need acidic pH for absorption (<7.35)

28
Q

acidic drug examples

A

penicillin, phenytoin, aspirin

29
Q

what binds to acidic drugs

A

albumin

30
Q

basic drug examples

A

diazepam, morphine

31
Q

what binds to basic drugs

A

A1-AG

32
Q

why do elderly have a higher volume of distributionfor lipophilic drugs

A

due to increase in fat they gain

33
Q

what can grapefruit juice + statins cause

A

myalgia

34
Q

what can cranberry juice cause

A

high INR

35
Q

what is the therapeutic index

A

minimum toxic concentration/ minimum effective dose