Older persons medicine Flashcards
(27 cards)
Type of nystagmus seen in BPPV?
Rotatory nystagmus
Risk factors for delirium?
PINCH ME and others
Pain, infection, nutrition, constipation, hydration, medications, environment
age > 65 years
background of dementia
significant injury- hip fracture
frailty or multi-morbidity
polypharmacy
metabolic changes
Management for delirium?
Treat underlying cause
If therapy is required and no Parkinson’s -> haloperidol
With Parkinson’s -> lorazepam, quetiapine, clozapine
Intracapsular un-displaced hip fracture management?
Internal fixation
Hemiarthroplasty if unfit
Intracapsular displaced hip fracture?
NICE recommend replacement arthroplasty (total hip replacement or hemiarthroplasty) to all patients with a displaced intracapsular hip fracture
Total hip replacement is favoured to hemiarthroplasty if patients:
-were able to walk independently out of doors with no more than the use of a stick and
-are not cognitively impaired
-are medically fit for anaesthesia and the procedure.
Alzheimer’s management?
Mild-moderate
2nd line
Mild-moderate: acetylcholinesterase inhibitors (donepezil, galantamine and rivastigmine)
2nd line: memantine (if others are CI, add-on drug or as monotherapy in severe Alzheimer’s)
Investigations for Dementia?
Blood screen ito exclude reversible causes (Hypothyroidism)
-FBC, U&E, LFTs, calcium, glucose, ESR/CRP, TFTs, vitamin B12 and folate levels
-DatScan + CT
Complications of Bisphosphonates?
-Oesophageal reactions- oesophagitis, ulcers
-Osteonecrosis of the jaw- more if IV
-Risk of atypical stress fracture- proximal femoral shaft
-Acute phase response: fever, myalgia and arthralgia
-Hypocalcaemia- clinically unimportant
Management of patients following a fragility fracture depends on age guidelines?
> 75 give oral bisphosphates without DEXA scan
<75 arrange DEXA scan first
Osteoporosis: assessing the risk of fragility fracture.
What are the risk factors
women >65 (+ menopause)
men >75
previous fragility fracture
current/ frequent use of steroids
FHx of fracture
low BMI <18.5
smoking
>14 units alcohol per week
secondary condtions: hypogonadism, DM, cushings, IBD, coeliac, RA
meds: SSRIs, PPIs, antiepileptics, glitazones
Investigations for BPH?
Urinedip
U&Es- chronic retention
PSA
Urinary-frequency volume chart- 3 days
Management for BPH?
watchful waiting
alpha-1 antagonists- tamsulosin, alfuzosin (IPSS >8 moderate-severe)
5 alpha-reductase inhibitors- finasteride (significantly enlarged prostate and is considered to be at high risk of progression) - can take 6 months to work
combination therapy (alpha-1 antagonist + 5 alpha-reductase inhibitor)
mixture of storage symptoms + voiding symptoms that persist -> antimuscarinic (anticholinergic) drug, tolterodine or darifenacin
surgery: transurethral resection of prostate (TURP)
Investigations for urinary incontinence?
bladder diary- 3 months
vaginal exam- prolapse
urine dip + culture
urodynamic studies
Urge incontinence management?
-bladder retraining- for 6 weeks
-antimuscarinics- oxybutynin, tolterodine, darifenacin
-mirabegron- elderly/ anticholinergic concern
-desmopressin if nocturia
-women with overactive bladder that has not responded to non-surgical management -> botox type A injections into bladder wall
Stress incontinence management?
-lifestyle measures- weight reduction, reducing caffeine intake
-pelvic floor muscle training- 3 months
-surgical (mid-urethral tape, bulking injections, colposuspension)
-duloxetine- if women declined surgery
Risk factors for falls in the elderly? (12)
Lower limb muscle weakness
Vision problems
Balance/gait disturbances (diabetes, rheumatoid arthritis and parkinson’s disease etc)
Polypharmacy (4+ medications)
Incontinence
>65
Have a fear of falling
Depression
Postural hypotension
Arthritis in lower limbs
Psychoactive drugs
Cognitive impairment
Investigations for falls in the elderly?
Bedside
Bloods
Imaging
Bedside tests:
Basic observations, blood pressure, blood glucose, urine dip and ECG
Bloods:
FBC, U&Es, LFT, bone profile
Imaging:
X-ray of chest/injured limbs, CT head and cardiac echo
Management for constipation?
lifestyle- increase water, fibre, activity
exclude faecal impaction
first-line laxative: bulk-forming laxative first-line, ispaghula
second-line: osmotic laxative, such as a macrogol
Secondary renal causes of HTN?
glomerulonephritis
pyelonephritis
adult polycystic kidney disease
renal artery stenosis
Common secondary cause of HTN?
primary hyperaldosteronism- Conn’s syndrome
Drug induced causes of HTN?
steroids
MOAs
the combined oral contraceptive pill
NSAIDs
leflunomide
Symptoms of myxoedema coma?
Management for myxoedema coma?
Altered mental status- hard to rouse
Brady cardia
Hypothermia
Hypotension
(Would have hypothyroidism features too)
Management:
IV thyroxine and hydrocortisone
What drugs increase mortality in dementia patients?
Antipsychotics (haloperidol, clozapine) due to risk of CVA/ stroke events
Which is the best assessment tool for differentiating between stroke and stroke mimics?
ROSIER
