P-3

Question 1

2/3 of medication related hospitalizations are 2/2

Answer 1

anticoagulants, antiplatelet and diabetes meds

Question 2

Technique for reducing likelihood of adverse medication effects and improving compliance

Answer 2

Pruning

• use combo agents
• discard drugs not needed
• consider prognosis (<10y ?)

Question 3

Pain

Answer 3

Nociceptive pain; usually 2/2 tissue damage

• subdivided into somatic and visceral pain
• Somatic pain: 2/2 injury to body tissues. localized
• Visceral pain: 2/2 viscera stretch receptors. poorly localized

Neuropathic/central pain:
- 2/2 a primary lesion or nervous system dysfunction

Wind-up pain:

• Slow temporal summation of pain
• mediated by C fibers.
• Repetitive noxious (<1 per 3 seconds) gradual increase

Question 4

Opioids

Answer 4

Oxycodone 1.5 x morphine
Hydromorphone 1.5 x morphine

Typ dose ~20mg

Question 5

Oral anticoagulants

Answer 5

Warfarin
- hepatic clearance, avoid if insufficient

Dabigatran

• Direct thrombin inhibitor
• 80% renal clearance, crcl 15-30 = 75mg bid

Rivaroxaban
- 60% renal clearance, crcl 15-50 caution

Question 6

Old and drunk

Answer 6

Women <65
- ≤ 7 drinks/week or and ≤ 1 drink/day
Men <65
- ≤ 14 drinks/week and ≤ 2 drinks/day

65+
- ≤ 1 drink/day men and women

Question 7

Postprandial syncope

Answer 7

due to Postprandial Hypotension
- 2/2 vagal stimulation

Also check for a fib which is common

Question 8

Leading cause of vision impairment

Answer 8

Cataracts

• blurred vision
• increased sensitivity to glare

Question 9

Leading cause of irreversible vision loss in people >65

Answer 9

Age related macular degeneration
- destroys the macula, impairing central vision

Nonneovascular (or dry) MC (90%)

• gradual blurring of central vision
• Tx = specific antioxidants and zinc supplements

Neovascular (or wet)

• rapid loss of central vision
• Tx = prompt referral to optho
• anti-VEGF intravitreal injections (maintain/mildly improve)

Question 10

Second leading cause of blindness worldwide

Answer 10

Glaucoma

• typically starts in the periphery and extends inward
• MC in African americans (near vehicle accident)

Tx goal: lower IOP, slow optic nerve atrophy

Question 11

Vision changes

Answer 11

Crystallin lens becomes less flexible with age
- less able to accommodate = presbyopia (far sighted)

Retina receives 1/3 the light of a 20 year old
- cataracts = less ability to see in dim light

Question 12

Referral indications for Vision loss

Answer 12

Vision loss or pain or painful vision loss

- refer to optho

Question 13

Joint pain

Answer 13

Gout = diet; podagra (big toe)

• acute = chochicine/steroids
• chronic = allopurinol/febuxostat, probenecid

Pseudogout = mechanical; Lg joints (Knee); hospitalized Px; pos birefringent
- cholchicine

Polymyalgia Rheumatica; bilateral aching, shoulder, hips, worse in AM
- steroids

Question 14

Back pain

Answer 14

activity modification

- PT or OT