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Geri > P-4 > Flashcards

P-4 Flashcards

1
Q

Medicare covers who

A

Anyone 65 years and older

Any age with

  • permanent disabilities receiving Social Security Disability payments
  • end-stage renal disease
  • amyotrophic lateral sclerosis
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2
Q

Medicare Part A

A

Hospital Insurance program

  • inpatient hospital services
  • short-term rehab (SNF/home health agency)
  • hospice care
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3
Q

Medicare Part B

A

Supplementary

- physician, outpatient, home health, laboratory, and preventive services

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4
Q

Medicare Part C

A

Medicare Advantage program

  • Allows enrollment in a private plan
  • HMO, PPO, or private fee-for-service plan
  • alternative to traditional fee-for-service

Part C is not separately financed

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5
Q

Medicare Part D

A

Outpatient prescription drug benefit

  • delivered through private plans
  • either standalone or Medicare Advantage drug plans

Part D generally = monthly premium

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6
Q

Medicaid

A

States having primary administrative responsibility, within national guidelines

  • States can establish their own eligibility
  • entitlement program = states must provide certain mandatory services to specified populations in order to receive federal funding
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7
Q

First line treatment for chronic venous insufficiency?

A

Compression stockings
- and elevation

Loop diuretics (Furosemide)
- can cause hypokalemia so give potassium with it
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8
Q

In geriatric patients, abdominal complaints often come from where?

A

Organs outside the abdomen.

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9
Q

In geriatrics, how will appendicitis present?

A

In some cases, a low grade fever and general abdominal pain are the ONLY symptoms

Severe pain not likely unless appendix perforates

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10
Q

MC pressure ulcers

A
  • Iliac crests
  • Sacrum
  • Greater trochanters
  • Ischial tuberosity
  • Lateral malleoli

MC in patients >70

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11
Q

4 key factors that cause pressure ulcers?

A

Pressure
Friction
Shearing
Maceration

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12
Q

Pressure ulcers Etiology/Risk Factors

A
  • Intrinsic Factors
  • Immobility/inactivity
  • Incontinence
  • Malnutrition
  • Naturally aging skin
  • PVD, DM (local ischemia)
  • Dementia
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13
Q

How often do you turn the pt to avoid ulcers?

A

Every 2 hours is ideal

  • Bedridden patients should have there head positioned no more than 30 degrees
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14
Q

Stages of pressure ulcer?

A

1 - Non blanching erethyma (skin intact)

2 - Partial thickness, Epidermis → dermis (blister/abrasion)

3 - Full thickness, Into subQ/facia (crater)

4 - Down to bone/tendon/muscle

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15
Q

Each and Every ulcer must be documented

A

Size, Location

Eschar, Granulation tissue

Exudate, Odor, Infection

Sinus Tracts, Undermining

Staging (I-IV)

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16
Q

Treatment for stage 1 and 2 pressure ulcers?

A
  • Assess, manage and control pain
  • manage local/distant infx (Silver Sulfa)

Clean (with NS only) and apply protective transparent dressing

17
Q

Treatment for stage 3 and 4 pressure ulcers?

A
  • Assess, manage and control pain
  • manage local/distant infx (Silver Sulfa)

Irrigation, debridement of necrotic tissue, healing by secondary intent, appropriate dressings, or surgical closure

18
Q

Ulcers that do not need debridement

A

If there are no signs of infection

  • Heel ulcers with stable, dry eschar
  • ± Stage I and II ulcers
19
Q

Ulcer complications

A

Infection:
- Cellulitis, osteomyelitis, bacteremia, sepsis

Topical Abx if no healing after 14d with Silver Sulfadiazine

  • May need surgical debridement
  • Systemic Abx for advanced cellulitis, osteomyelitis, sepsis

Pending Cx, Abx should cover MRSA, anaerobes, enterococci and gram negative bacteria

20
Q

Treatment for depression in elderly?

A

Zoloft (sertraline) 1st line safer with cardiac dz
- also used for PTSD and MDD

2nd line is SNRI - venlafaxine, desvenlafaxine, duloxetine

  • Bupropion for tobacco cessation
  • Mirtazapine = appetite stimulant and helps with insomnia

Titrate dose at 5 weeks
- can take 12 weeks for effect

Therapeutic dose x 6 weeks with no change
- consider augmenting with bupropion

21
Q

Depression follow up/referral

A

Tx continued for 6 months

  • if relapse occurs tx for 1-2 years or indefinitely
  • D/C meds over 3 month period

Refer to psych if a SNRI and bupropion are not working

22
Q

What SSRI has a FDA warning for QT prolongation

A

Citalopram
- QT prolongation at doses >40mg/day

Fluoroquinolones (Azithromycin) also cause QT prolongation

23
Q

1st line drugs used for HTN

A

B blockers - not without CV disease

  • good for systolic dysfunction and CAD
  • bad with asthma/COPD, AV blocks

ACE inhibitors

  • good for diabetics, CHF, LV dysfunction
  • SE cough (try ARB), hyperkalemia (monitor), severe renal insufficiency

HCTZ
- SE: hypokalemia, hyperuricemia (gout), urinary frequency (night time fall risk)

24
Q

Drugs used for HF

A 
HFpEF
Loop diuretic (furosemide)
- SE = hyperkalemia (check 1wk after starting)

HFrEF
B blocker
- Good with HTN
- Bad with asthma/COPD AV blocks

ACE/ARB

  • Good with HTN, DM, LV dysfunction
  • SE cough (try ARB), hyperkalemia
25
Q

Drugs to avoid with HF

A
  • NSAIDs and COX-2 inhibitors
  • NonDHP CCBs (diltiazem, verapamil)HFrEF
  • Thiazolidinediones (pioglitazone, rosiglitazone)
  • Cilostazol
  • Dronedarone
26
Q

Drugs used for Dementia

A
  • Cholinestarase Inhibitors = donepezil, rivastigmine, galantamine
  • NMDA antagonist = Memantine Added to ChEI
  • SSRIs
  • Olanzapine
  • Haloperidol(IM acute Tx)
27
Q

Drugs to avoid with dementia

A
  • Anticholinergics (-amine)
  • Benzodiazepines
  • H2-receptor antagonists (-tidine)
  • Nonbenzo agonist: Eszopiclone, Zolpidem, Zaleplon
  • Antipsychotics (-azine & -apine)
28
Q

Anticholinergics

A

Antihistamines:

  • a bunch ending in -amine
  • Cyproheptadine, Triprolidine
  • Hydroxyzin, Meclizine
  • Dimenhydrinate
  • Clemastine

Antiparkinsonian agents
- Benztropine, Trihexyphenidyl

Skeletal muscle relaxants
- Cyclobenzaprine, Orphenadrine

29
Q

TCA’s

A

Amoxapine, Doxepin
Imipramine, Trimipramine
Nortriptyline, Protriptyline, Amitriptyline

30
Q

Drugs to avoid with a Hx of falls/fractures

A
  • Anticonvulsants
  • Antipsychotics
  • Benzodiazepines
  • Nonbenzo agonist: Eszopiclone, Zolpidem, Zaleplon
  • TCAs, SSRIs
  • Opioids
31
Q

Normal values

A 
TSH = 0.5 - 4.0
T4 = 5 to 12
CrCl = 0.9 to 1.0
HMG = 12 to 15
HCT = hmg x 3 = 45

Geri (11 decks)

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