Theory

Question 1

Give some examples of what would contribute to a problem list of a patient

Answer 1

Problem list is a differential diagnosis with other non-medical problems

Heart murmur
Frailty syndromes; falls, confusion, polypharmacy
Non-medical issues; poor housing, isolation

Question 2

Outline the components of the CGA (comprehensive geriatric assessment)

Answer 2

Medical; problem list, co morbidities, medication review, nutritional status

Functioning; basic activites and daily living (ADLs), exercise status, gait/balance

Psychological; mental status/ cognitive function, mood/depression testing

Social/environment; informal needs, social circle

Question 3

What are the 4C antibioitcs

Answer 3

Ciprofloxacin
Co-amoxiclav
Clindamycin
Cephalosporins

Question 4

What are some of the features required to diagnose delerium?

Answer 4

Acute change in mental status fluctuating over the course of the day
&
Inattention (easily distracted cant hold convo)
&
Disordered thinking
OR altered consciousness

Question 5

What are the 4 principles that determine the pharmacokinetics of a drug?

Answer 5

Absorption
Distribution
Metabolism and excretion

Question 6

What are some of the physiological changes that alter the absorption of drugs in the elderly?

Answer 6

They have increased gastric PH
Decrease in small bowel surface area
NG tubes or PEG feeds
Low albumin but higher A-1 AG so absorb more basic drugs than acidic.

Question 7

What is the protein carrier molecule for acidic drugs?

Answer 7

Albumin

Question 8

What is the protein carrier molecule for basic drugs?

Answer 8

Alpha-1 acid glycoprotein

Question 9

Give some exapmples of acidic drugs

Answer 9

Pheytoin
Aspirin
Penicillins

Question 10

Give some examples of basic drugs

Answer 10

Diazepam
Morphine
Pethidine

Question 11

What is the difference between modified release morphine and immediate release morphine? Give examples of each

Answer 11

Modified release is for background pain and is slow release over 12 hrs. E.g MST and zomorph

Immediate release is for breakthrough pain on PRN which lasts only 4hrs. E.g cevradol and oramorph.

Question 12

What is the calculation for breakthrough dosage of morphine compared to modified release?

Answer 12

Breakthrough dose is 1/6 of the background dose e.g 30mg background per day= 5mg of breakthrough dose PRN

Question 13

What would the signs in order of severity to indicate opiod toxicity

Answer 13

Hallucinations
Vivid dreams
Confusion
Myoclonus
Sleepiness
Pin point pupils
Resp depression