OLDER ADULTS END OF LIFE Flashcards
licensed for use in patients with moderate-to-severe dementia in Alzheimer’s disease?
Memantine
licensed for use in patients with mild-to-moderate dementia with Alzheimer’s disease
Donepezil, galantamine and rivastigmine
2 drug groups that are the likely cause of being admitted to hospital due to an adverse drug reaction for elderly on multiple medications
NSAIDs and duiretics
Which is the SINGLE MOST likely psychological consequence of a fall?
Loss of confidence
has most evidence of efficacy in managing an elderly person with recurrent falls?
Medication review
most sensitive indicator of any dangerous decline in clinical condition
respiratory rate
Regarding herpes zoster vaccination, HOW MANY older adults need to be vaccinated to prevent ONE case of shingles?
50 (Number needed to benefit)
which is the SINGLE MOST appropriate assessment to use when diagnosing delirium?
4AT
SINGLE MOST appropriate INITIAL screening investigation for a patient with memory loss?
B12
medication (amitriptyline and codeine) and her reduced appetite, likely cause of delirium
constipation
PINCH ME: pain, infection, nutrition, constipation, hydration, medication, environment
MINIMUM duration of weekly moderate-intensity exercise in minutes for >65
150 mins (ideally 30 mins for 5 days a week
increases toxicity of lithium, which drug groups? 4 answers
NSAIDs, ACEi/ARB, diuretics, antidepressants
Proliferation of which ONE of the following immunoglobulins (Ig) is MOST LIKELY in multiple myeloma
IgG
examples cholinesterase inhibitor symptom modifying drugs for dementia
Donepezil, galantamine and rivastigmine ALL HAVE SIMILAR EFFICACY
Antipsychotics should be used as a last resort in any form of dementia but avoided in?
Lewy Body dementia
Which of the following exercises best promotes balance, mobility and coordination?
Yoga
appropriate ESTIMATION of the percentage of falls in older people in the community that result in a fracture?
Less than 10% (around 5%)
dementia with parkinson’s signs?
Lewy Body dementia
medication is licenced for management of refractory orthostatic hypotension
Midodrine
Examples of medications with a high anti-cholinergic burden which can mimic problrms with cognition include
amitriptyline, oxybutynin, and paroxetine.
medication (group) that interferes with glucose regulation/precipitating factor for hyperglycaemia or HHS
beta blockers
The use of which drug group has been shown to be associated with adverse metabolic effects including hypokalaemia, hypomagnesaemia, hyperuricaemia, dyslipidaemia, and impaired glucose metabolis
thiazides
Which is the SINGLE MOST common cause of end-stage renal failure in the UK?
Diabetes
SINGLE MOST important risk factor for developing gastric cancer
H pylori
occurrence of well formed, vivid, elaborate and often stereotyped visual hallucinations in a partially sighted person who has insight into the unreality of what he or she is seeing
Charles Bonnet syndrome
beneficial component of a multifactorial intervention for recurrent falls in older people
Strength and balance training
simple test that can be used to identify those at higher risk of functional decline and falls
Timed Up and Go test
score in timed up and go test that have been shown to indicate high risk of falls in older people
12-15 seconds or more
For ADULTS who do NOT have a chronic medical condition, what is the MINIMUM AGE required to be entitled to the pneumococcal vaccination?
65
drugs associated with an increased risk of mortality and TIA in ederly
antipsychotics/risperidone
only licensed for use in Alzheimer’s disease although it can be considered for people with severe dementia with Lewy bodies
Donepezil
licensed for mild-to-moderate dementia associated with Parkinson’s disease
Rivastigmine
unable to remember some facts like address but no functional impairment?
cognitive ageing
oral morphine to subcut diamorhpine conversion
30mg to 10 mg (divide oral morphine by 3)
end of life unable to take anti epileptics orally, what to do
prescribe midazolam continuous subcut infusion
equivalent dose of 25 fentanyl patch into morphine oral
60 mg oral morphine
when does oral morphine solution becomes controlled drug
when concentration is above 13mg/5ml
first-line treatment for vomiting due to raised intracranial pressure
cyclizine
Nausea and vomiting related to opioids is usually well treated with
dopamine-receptor antagonists such as haloperidol or metoclopramide
This drug should be mixed with water for injection rather than 0.9% saline to reduce the chance of precipitation
cyclizine
treatment for nausea and vomiting due to opioids
haloperidol or metoclopromide
loading dose of dexamethasone
16mg
form to be completed for potentially terminal illnes
SR1
management options for intractable hiccups
peppermint water, metoclopromide, simeticone, domperidone PPI
management of seizure for brain tumour patients finishing course of dexamethasone
midazolam via syringe driver or rectal or buccal
part of the Gold Standards Framework proactive identification guidance
Timed up and go test (TUGT)
guidance for clinicians to support earlier identification of patients nearing the end of life, leading to improved proactive person-centred care
Gold Standards Framework
Blood glucose targets for diabetic patients on end-of-life care with a prognosis of months or less to live should be adjusted. What is an appropriate target?
Blood glucose level should be between 6 and 15 mmol/l
first-line drug treatment for treating nausea or vomiting in people in the last days of life with obstructive bowel disorder? Second line?
Hyoscine butylbromide, octreotide second line
first-line management for end stage COPD with maximal therapy - still breathless
Use of controlled breathing techniques
treatment for the relief of symptoms of SVCO in adults with bronchogenic carcinoma
Stent insertion
first-line anti-emetic of choice for the management of drug-induced or metabolic causes (e.g. hypercalcaemia, renal failure) of nausea and vomiting in palliative care.
haloperidol
anti emetic easily discouloured in a solution
metoclopromide
Which of the following drugs is contraindicated for use in syringe drivers as it causes skin reactions at the injection site?
Chlorpromazine
may be given for short periods for cancer-related fatigue and lethargy
Dexamethasone
