Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Neuro and geriatrics > Geriatrics > Flashcards

Geriatrics Flashcards

1
Q

What is geriatric medicine?

A

Branch of general medicine concerned with older people
Older people are main users of both health and social services
Challenges of frailty, complex co-morbidities, different patterns of disease presentation, slower response to treatment and requirements for social support call for special medical skill

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is frailty?

A

State of increased vulnerability resulting from ageing associated decline in reverse and function across multiple physiologic systems such that the ability to cope with everyday or acute stressors is compromised

  • Not inevitable
  • Not simply due to multiple long term conditions
  • Not irreversible
  • Poor functional reserve
  • Vulnerable to decompensation when faced with illness, drug S/E, metabolic disturbance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How do complex co-morbidities relate to geriatrics?

A

Often people who are older have more diagnoses than those who are younger
Can be linked
Can be unlinked
Acute presentations on top of this
People with frailty and co-morbidities often have prolonged death and their decline often more unpredictable
How important is it to start treatments that take months to work?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What conditions may present differently in older people?

A 
Falls
Confusion
Off legs - generally unwell
Incontinence
Chest pain, SOB, urinary symptoms
Social admission
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the 5M’s of geriatric giants?

A 
Mind
Mobility
Medications
Multi-complexity
Matters most
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What does mind mean?

A

Dementia
Delirium
Depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What does mobility mean?

A

Impaired gait and balance

Falls

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What do medications mean?

A

Polypharmacy
Deprescribing/optimal prescribing
Adverse effects
Medication burden

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What does multi-complexity mean?

A

Multi-morbidity

Bio-psych-social situations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What does matters most mean?

A

Individual meaningful health outcomes and preferences

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is a social admission?

A

Non-specific presentations are tricky
Medical slang
Used to describe patients unable to cope with ADLs
No acute medical problem, inappropriate admission
Negative
Often have serious underlying pathology that will be missed if you don’t search

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the treatment like in geriatric medicine?

A 
Essentially the same
Much more prone to S/E and interactions
Reduced organ function
Lack of evidence for treatment in older patients
Often multiple patholgies to balance
How relevant is secondary prevention when you're old
Polypharmacy
Slower response to treatment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is deconditioning?

A

Bedbound for days/weeks
Confused
Poor nutritional state even prior to admission, made worse by acute illness
Can’t walk, falls, can’t look after themselves
Need more than just medicines
Comprehensive geriatric assessments
- Tailor social and environmental assessment to patient
- Require MDT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What do you need to take into account in rehabilitation?

A

Process of restoring patient to max function (need to know pre-morbid function)
Can happen in variety of settings, in and out of hospital
Involves MDT, including doctors
Leads to process of discharge planning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the legal and ethical issues?

A

Care at end of life (fluids, feeding, antibiotics)
Discharge destination
Dementia/delirium
MCA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is important to take into account with vulnerable patients?

A

Safeguarding
Abuse
Physical - neglect, psychological, financial, discriminatory, institutional, sexual

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is important to take into account with death and dying?

A 
Lots of patients die
Inevitable consequence of illness
Important we recognise dying and act appropriately
One chance to get it right
May be difficult or upsetting
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the NEWS score?

A

Score that determines illness of a patient and how quickly we need to act

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What assessments should you do during ABCDE?

A

NEWS
GCS
AMI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What investigations should you do for pneumonia?

A

Disability - GCS, AMT, blood glucose
Bloods + culture, ABG
Raised neutrophils - bacterial infections
CXR - to see R lower lobe do lateral film
ECG
Sputum culture
Urine for pneumococcal antigen and legionella in moderate and severe CAP
CURB65

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the scores in CURB65?

A 
Confusion AMT = / 7
Urea > 7
RR > 30
BP S < 90 D = / < 60
Age > 65
Score
- 0-1 < 3% mortality
- 2 9% mortality
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How do you manage pneumonia?

A

High flow O2
Antibiotics - clarithromycin + co-amox IV
Paracetamol if pyrexic
Fluids if AKI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the features of consolidation?

A

Dull to percussion
Crepitations
Bronchial breathing
Describe limitations of consolidation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is HAP?

A

More than 48 hours after admission
Different antibiotic approach - broad spectrum
G -ve MRSA
AB policy will tell you what to prescribe depending on C/HAP and CURB65

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What should you think of in a patient with pneumonia and a stroke?

A

Aspiration pneumonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are the symptoms of aspiration pneumonia?

A 
Chest pain
Coughing
Fatigue
Fever
SOB
Wheezing
Breath odor
Excessive sweating
Problems swallowing
Confusion 
Blue discolouration of skin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What does COVID pneumonia look like?

A

Affects edge of chest and lower lobes most
Ground glass appearance
ARDS - completely opaque chest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

How do you manage COVID pneumonia?

A 
Isolate
NO ABX
O2
Supportive care - rest, VTE prophylaxis, management of co-morbidities, fluids, immunosuppressant alteration
Early ID of illness monitoring
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are the complications of pneumonia?

A

Post-pneumonia pleural effusion
Lung abscess after pneumonia - consolidation can become neurotic has fluid level on MRI
Pus in pleural sac - empyema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What should you look out for in a geriatric with infection?

A

Sepsis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What could LIF pain with pyrexia suggest?

A

Diverticulitis +/- abscess

Peritonitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is vesicular breathing?

A

Normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is bronchial breathing?

A

Longer expiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is air under the R diaphragm called?

A

Pneumoperitoneum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is erysepilas?

A

Red skin caused by strep penicillin Tx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

When should you give fluids in sepsis? And what would you prescribe?

A

If systemic symptoms like sinus tachycardia, CPT, BP
Fluid resuscitation (bolus saline 500mls over 15 mins)
Reassess and repeat if required

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What antibiotic should you give for intra-abdominal sepsis?

A

Tazacin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What investigations should you do for someone with sepsis?

A 
FBC, CRP
Blood cultures
U&E, LFTs
Lactate, blood glucose
Lactate - raised if tissue damage
CT abdo pelvis if abdo symptoms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What is sepsis?

A

Systemic inflammatory response to infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What is the sepsis 6?

A 
Fluids - fluid balance chart, fluid resus
Blood cultures
Abx - IV
Urine output
Lactate
O2 - 24% O2 PO2 > 94%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

How else should you treat sepsis?

A 
NBM
Analgesia IV
Anti-emetics if morphine
Fluid balance - maintenance 30ml/kg/day
KCl 1mmol/kg
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Why is potassium needed in the body?

A

Vital for regulating normal electrical activity of the heart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What happens when K+ increases in the body?

A

Reduced myocardial excitability, with depression of both pacemaking and conducting tissues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What happens with progressively worsening hyperkalaemia?

A

Suppression of impulse generation by SAN and reduced conduction by AVN and his-purkinje system leading to bradycardia and conduction blocks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What is the definition of hyperkalaemia?

A

K+ > 5.5
Moderate > 6.0
Severe > 7.0

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What does an ECG of hyperkalaemia look like?

A 
Tall tented T waves (repolarisation abnormalities) > 5.5
Absent P waves (progressive paralysis of atria) > 6.5
Prolonged QRS and bradycardia > 7
Cardiac arrest > 9
Tall tented T waves
Prolonged PR segment
Loss of P waves
Bizarre QRS
Sine wave (pre-cardiac arrest)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What are the causes of hyperkalaemia?

A 
MACHINE
Medications
Acidosis - metabolic/respiratory
Cellular destruction 
Hypoaldosteronism (Addison's) or haemolysis
Intake - excess
Nephrons/renal failure
Excretion impaired
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What medications can cause hyperkalaemia?

A

ACEi
NSAIDs
Potassium sparing diuretics - spironolactone
Trimethoprim

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What are the signs and symptoms of hyperkalaemia?

A 
MURDER
Muscle weakness
Urine - oliguria, urea
Respiratory distress
Decreased cardiac contractility
ECG changes
Reflexes - hyper/areflexia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What is the management of hyperkalaemia?

A

AIRED
Administer IV calcium gluconate 10ml IV slowly with ECG monitoring/repetition
Increased excretion - calcium resonium 15g 8hr intervals to help excrete through gut
Remove sources of potassium - IV/oral
Enhance potassium uptake into cells - insulin 10 units in 50ml 50% dextrose over 15 mins in large vein OR 10/20% dextrose in 250ml over 60 mins
Dialysis if severe
Also add salbutamol 10mg nebuliser

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What is the definition of hypokalaemia?

A

K+ < 3.5
Moderate < 3
Severe < 2.5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What are the ECG changes in hypokalaemia?

A 
Increased amplitude and width of P wave
Prolongation of PR interval
T wave flattening and inversion
ST depression
Prominent U waves
Apparent long QT interval due to fusion of T and U waves
Ectopics
Supraventricular tachyarrhythmias
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What are the causes of hypokalaemia?

A

Body trying to DITCH K+

  • Drugs - loop diuretics
  • Inadequate consumption
  • Too much water
  • Cushing’s
  • Heavy fluid loss
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What are the signs and symptoms of hypokalaemia?

A

7Ls (low)

  • Lethargic
  • Low, shallow respirations… failure
  • Lethal cardiac disrhythmias
  • Lots of urine (frequency and large volume)
  • Leg cramps
  • Limp muscles
  • Low BP (severe)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

What is the management of hypokalaemia?

A

Oral or IV K+

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What is diabetes?

A

Chronic health condition where blood glucose level is too high
Happens when the body doesn’t produce enough insulin or when you can’t produce any at all
In older adults most likely to be T2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

How common is diabetes?

A

1 in 15 people have diabetes - including 1 million people who have T2 but haven’t been diagnosed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

How do older adults differ in diabetes?

A 
Clinical presentation
Psychosocial environment
Resource availability
Living situation
Degree of available social support
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What are the signs and symptoms of T2DM?

A 
Polyuria and polydipsia
Increased hunger
Unintended weight loss
Fatigue
Blurred vision
Slow healing sores
Frequent infections
Numbness or tingling in hands or feet
Areas of darkened skin - usually in armpits and neck
Repeatedly getting thrush
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

How is diabetes management in the elderly different?

A

Individualised care plan - take into account age, preferences, co-morbidities, and risk of adverse effects from medications
Lifestyle modification but not restrictive diets
Medication - consider drug interactions and risk of hypoglycaemia
Exercise - consider physical abilities
HbA1c goal equivalent to co-morbidities/end of life

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

What special considerations should you make for elderly with diabetes?

A

Presence of age-related conditions and interference with ability to perform diabetes self care
Polypharmacy - increased risk of drug interactions
Visual impairments - social isolation, errors in treatment, traumatic falls, disability
Risk of hypoglycaemia and risk of triggering CVS events and increased falls and fracture risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

What investigation should you do for diabetes?

A

Urine dip

HbA1c, fasting glucose, random plasma glucose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

How is diabetes diagnosed?

A

If symptomatic - single abnormal HbA1c or fasting glucose
If asymptomatic - repeat testing
HbA1c > 48
Fasting > 7
Random > 11.1 in presence of S&S of diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

What is the cause of diabetes?

A

Cells in muscle, fat and liver become insulin resistant
Cells don’t make enough sugar as don’t respond to insulin
Pancreas can’t make enough insulin due to fatty deposits in beta-cells and cells become impaired

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

How can you prevent diabetes?

A 
Healthy lifestyle
Eating healthy foods
Active
Weight loss
Avoiding inactivity for long periods
Medication to prevent progression from prediabetes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

What are the risk factors for diabetes?

A 
Overweight
Fat distribution
Inactivity
Family history
Black, hispanic, native american, asian, and pacific islander ethnicities
High levels of trigylcerides
Increasing age
Prediabetes
Pregnancy-related risks
POCS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

What are the complications of diabetes?

A 
Skin conditions
Slow healing
Hearing impairment
Sleep apnoea
Dementia
Macrovascular
- IHD
- PVD
- Cerebrovascular disease
Microvascular
- Retinopathy
- Nephropathy
- Neuropathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

What are the complications of diabetes in older adults?

A

More at risk for acute and chronic vascular complications
Major lower extremity amputations, MI, visual impairments, ESRD
Over 75 more likely to develop complications, higher rates of death from hyperglycaemic crises, and increased rate of ED visits
Higher risk of geriatric syndromes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Name 4 examples of geriatric syndromes

A 
Cognitive dysfunction
Depression
Physical disability
Pain
Polypharmacy
Urinary incontinence
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

What is osteoporosis?

A

Progressive loss of bone mass associated with change in bone micro-architecture
Associated with reduced cross linking within trabecular bone resulting in cortical thinning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

How does remodelling work?

A

Osteoblasts - make bone
Osteoclasts - destroy bone
Balance between the two
Allows bone to adapt to stressors and repair microdamage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

What happens in osteoporosis?

A

Shift towards bone resorption leading to net bone loss
Osteoclasts function in less regulated manner perforating through trabecular plate
No framework for osteoblast activity and structural integrity lost
Loss of connectivity between trabecular plates typical of microstructural changes associated with osteoporosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

What are the risk factors for osteoporosis?

A

SHATTERED
Steroid use of > 5mg for > 3 months
Hyperthyroidism, hyperparathyroidism, hypercalciuria
Alcohol and tobacco use
Thin BMI < 18.5
Testosterone decreased eg in prostate cancer treatment
Early menopause
Renal or liver failure
Erosive/inflammatory bone disease eg myeloma or rheumatoid arthritis
Dietary calcium decreased/malabsorption, diabetes mellitus type 1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

What investigations should you do in osteoporosis?

A

Bloods - FBC, U&E, LFT, TFT, calcium, phosphate, vit D, PTH, coeliac serology, myeloma screen
DEXA
Spinal x-ray
Bone turnover markers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

What is the management of osteoporosis?

A 
Lifestyle changes
Vitamin D and calcium
Bisphosphonates
Denosumab - monoclonal antibody
Raloxifene - selective oestrogen receptor modulator
Teriparatide - anabolic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

What are the complications of osteoporosis?

A

Bone fractures

Hip fractures - disability, increased risk of death especially in elderly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

How does skin protect against pressure damage?

A

Pacinian corpuscles - receptors that detect pressure changes/vibration on skin
pH mantle between 4-6 maintaining normal flora
Sebum production - antimicrobial and sealant properties
Langerhans cells providing tissue immunity
Effective perfusion to skin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

What is a pressure ulcer?

A

Injury to skin and underlying tissue that predisposes patient to infection - life threatening

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

How do pressure ulcers form?

A

Localised external pressure on skin - occlusion of capillaries and tissue compression
- Insufficient O2 and nutrients reaching tissues
- Altered soft tissue hydration - fluid pushed away from viable cells
Can affect any area of the body put under pressure - most common on bony areas of body

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

What are the risk factors for pressure ulcers?

A 
Limited mobility
Sensory impairment
Malnutrition
Dehydration
Obesity
Cognitive impairment
Urinary and faecal incontinence
Reduced tissue perfusion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

What is slough?

A

Yellow-green layer with pale pink base - mixture of fibrin, cell breakdown products, serous exudate, leukocytes and bacteria, doesn’t necessarily imply infection and can be part of normal healing process

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

What is eschar?

A

Tan/brown/black dead skin that sheds and falls of skin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

What are stage 1 ulcers like?

A 
Non-blanching erythema
- Skin intact
- Non-blanching redness
- Localised
- Painful
- Bluish tinge
- Warm
 May be difficult to detect in patients with deeper skin tones
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

What are stage 2 ulcers like?

A 
Partial thickness tissue loss
Loss of dermis - shallow open ulcer
Red/pink wound bed - no slough
May also present as blisters - open/ruptured, serum fulled
Not to be confused with moisture lesions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

What are stage 3 ulcers like?

A

Full thickness tissue loss
Subcutaneous fat may be visible
Bone, tendon, or muscle NOT visible or directly palpable
Slough or eschar may be present
Wounds with 100% eschar or slough at least stage 3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

What is a moisture lesion?

A 
Redness or partial thickness skin loss of epidermis, dermis or both
Caused by excessive moisture
- Urine
- Faeces
- Sweat
Not to be confused with pressure ulcers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

What is a stage 4 pressure ulcer?

A

Full thickness tissue loss
Exposed bone, tendon or muscle - visible or directly palpable
Depth of stage 3 and 4 can depend of anatomical structure
High risk for osteomyelitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

What is an unstageable pressure ulcer?

A

Base of ulcers need to be visible in order to stage
Some can be completely covered by slough or eschar
Cannot be stage but must be 3 or 4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

What does a deep tissue injury look like?

A

Damage of underlying soft tissue
Purple localised area of discoloured intact skin
Blood-filled blister
May be painful or warm
May expose additional layers of tissue despite optional treament

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

What is an acquired pressure ulcer?

A

Occur within care facility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

What is an inherited pressure ulcer?

A

Patient moves into facility with ulcer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

What can pressure ulcers to classified as?

A

Acquired/inherited
Avoidable/unavoidable
95% unavoidable

93
Q

When are pressure ulcers reported as clinical incidents?

A

Stages 2, 3, 4

3 and 4 serious

94
Q

How are pressure ulcers treated?

A 
Changing positions to relieve pressure on already developed ulcers and prevent more
Mattress and cushions
Dressings
Barrier creams
Antibiotics if required
Diet and nutrition
Hydration
Debridement - surgical or maggots
Surgery
95
Q

How do you prevent pressure ulcers?

A 
SSKIN
Support surface
Skin assessment
Keep moving
Incontinence and moisture
Nutrition and hydration
96
Q

What are the causes of iron deficiency anaemia?

A

Decreased iron intake
Increased iron loss
Increase iron requirements - not common in the elderly

97
Q

What are the signs and symptoms of iron deficiency anaemia?

A 
Often asymptomatic and only causes mild symptoms
Fatigue
Dyspnoea
Headache
Palpitations
Pale skin or conjunctiva
98
Q

What are the symptoms of underlying conditions that could be associated with iron deficiency anaemia?

A

Dysphagia - oesophageal malignancy
Dyspepsia - gastric cancer, PUD
Abdominal pain - coeliac disease, intrabdominal malignancy, IBD
Change in bowel habit - bowel cancer, coeliac disease, IBD
Rectal bleeding - anal fissure, rectal cancer, haemorrhoids, IBD
Weight loss - IBD, bowel cancer

99
Q

What is the clinical presentation of iron deficiency anaemia?

A 
Conjunctival pallor
Angular chellitis
Atrophic glossitis
Koilonychia
Dry skin and hair
100
Q

What is the criteria for iron deficiency?

A

Hb < 130 in men

Hb < 120 in women

101
Q

What are the investigations for iron deficiency?

A 
FBC
- Hb and haematrocrit
- MCV
- MCH
- RDW
Ferritin
Transferring saturation and total iron-binding capacity
Blood film
Urinalysis
102
Q

What is the treatment for iron deficiency anaemia?

A

Eat more iron-rich foods eg dark-green leafy vegetables
Oral iron binding replacement therapy
S/E - nausea, GI irritation, constipation or diarrhoea
Ascorbic acid supplementation
IV iron replacement
Red cell transfusion

103
Q

What are the complications of iron deficiency anaemia?

A

More at risk of illness and infection

Higher risk of heart failure with severe anaemia

104
Q

What are the common neural causes of syncope?

A

Vasovagal syncope
Carotid sinus hypersensitivity
Situational eg micturition

105
Q

What are the common cardiac causes of syncope?

A

Postural hypotension

Arrhythmias eg bradycardia, tachycardia, hypotension, long QT

106
Q

What types of bradycardias can cause syncope?

A

Heart block/sick sinus syndrome

107
Q

What types of tachycardia can cause syncope?

A

VT/SVT

108
Q

What are the common non-cardiogenic causes of syncope?

A

Psychogenic
Metabolic
Medications

109
Q

What are the clinical features suggesting cardiac causes of syncope?

A 
SOB
Reduced exercise tolerance or happened during exercise
Chest pain or palpitations
Oedema
Heart murmurs
No prodrome
Symptoms occur when sitting and lying down
FHx of sudden cardiac death
110
Q

What is postural hypotension?

A

Persons blood pressure drops abnormally when they stand up after sitting or lying

111
Q

How do you test postural hypotension?

A

Symptomatic gives diagnosis
Standing for more than 3 minutes - check multiple times over these minutes
First thing in the morning and check a few times throughout the day as they can be situational

112
Q

What is the rate of drop to diagnose postural hypotension?

A

Drop by S > 30, or D > 20

S < 90

113
Q

What are the causes of falls in older people?

A 
Cardiac causes
Neural causes
Metabolic causes
Balance problems
Muscle weakness
Poor vision
Heart disease
Syncope
Dementia
Hypotension
114
Q

What are the complications of falls?

A 
Fractures
Head injuries
Pressure sores
Becoming less active and therefore weaker and increased chance of falling - post fall syndrome
Carpet burns
115
Q

What are the complications of long stays on the floor following falls?

A 
Dehydration
Hypothermia
Pneumonia - related to hypothermia
AKI - from dehydration and rhabdomyolysis
Rhabdomyolysis
Death
Distress
116
Q

What is vasovagal syncope?

A

Syncope due to stress

117
Q

What stressors can cause vasovagal syncope?

A

Pain/heat
Sight of blood
Prolonged standing
Mental stress

118
Q

What is carotid sinus hypersensitivity?

A

When external pressure is placed on the carotid sinus automatically reduced HR - normal
In hypersensitivity - overreacts to pressure causing HR to slow down or BP to drop significantly
Can be by wearing tight clothing around neck or turning head

119
Q

What is sick sinus syndrome?

A

SAN cannot create a HR that is appropriate for body’s needs
Causes irregular heart rhythms
Previous MI

120
Q

Name 2 intrinsic risk factors for falls

A

Female
Cognitive decline
Visual problems
Muscle weakness

121
Q

Name 2 extrinsic risk factors for falls

A

Polypharmacy

Lots of hazards around home

122
Q

What are the causes of postural hypotension?

A

Age related impairment of baroreflex mediated vasoconstriction and chronotropic responses of heart
Deterioration of diastolic filling of heart
Dehydration
Hypoglycaemia - secondary
Adrenal disease - secondary
Eating meals - postprandial hypotension
Medications - recent changes?

123
Q

How does COVID present?

A 
Asymptomatic
Mild viral illness
Pneumonia
Anosmia
Loss of taste
Thrombotic effects 
Renal failure
Skin manifestations
Respiratory failure
Mortality
124
Q

What are the risk factors for a more severe covid?

A 
Ethnicity
BMI
Co-morbidities - diabetes, CVS
Immunosuppressed
Age
125
Q

What investigations do you do in a suspected covid case?

A

Swab
Bloods - FBC, U&E, CRP, LFT, PCT, ferritin, D dimer
CXR - NAD, classic COVID change

126
Q

What should you note about a covid patient?

A

Clinical frailty score
Date of onset of symptoms
Date of positive swab

127
Q

What management should you put in place for covid patients?

A 
Escalation plan
DNAR
Antibiotics
Fluids
Trail participant
Phone family
O2
Good nursing care
Physio
128
Q

What should you monitor in covid patients?

A

Sats

RR

129
Q

What should you discuss with family?

A 
General covid discussion
Potential to suddenly deteriorate
DNAR
Escalation
Regular follow-ups
130
Q

What are the s/e of covid?

A 
Delirium
General decline and rapidly increased frailty
Poor oral intake
Unpredictable deterioration
- Sudden increase in RR and drop in sats
- Florid new changes on CXR
- Check PCT again, give antibiotics if any indication
- Increase O2 as needed
- Most died, often very rapidly
131
Q

What do you put in place for palliation?

A 
O2
Rationalise medications
Pre-emptive prescribing of drugs for symptoms control +/- syringe driver
Update family ?visiting
Support from whole MDT
132
Q

What pre-emptive medications should you give someone who is dying?

A

Morphine
Midazolam
Hyoscine
Haloperidol

133
Q

What is the background of major trauma in the elderly?

A

Don’t always present typically - often different mechanisms of injury
Older patients have less senior reviews
Most common cause of major trauma is small falls in elderly
Frail patients with severe injuries are at risk of under-triage, delayed diagnosis, and sub-optimal care
Osteoporosis under-diagnosed and under treated

134
Q

How common are hip fractures?

A

66,500 hip fractures per year

135
Q

What is the 30 day mortality for hip fractures?

A

7%

136
Q

What is the year mortality for hip fractures?

A

30%

137
Q

What are the NICE guidelines for hip fractures?

A 
Orthogeriatric assessment within 72 hours
Surgery within 36 hours
Rehabilitation to as best function as possible
Prompt mobilisation after surgery
Pre-operative cognitive testing
Delirium assessment post-operatively
Return to original residence by 120 days
Fracture prevention assessments
Nutritional assessment
138
Q

What are the two types of orthogeriatric care?

A

Fracture liaison services
- Admitted under ortho
- Provides input within 72 hours
Dedicated orthogeriatric ward
- Admitted directly to dedicated hip fracture ward
- Usually admitted under ortho but transferred post-op
- Both specialities provide input during admission

139
Q

How can frailty be prevented?

A

Good nutrition
Physical activity
Avoid social isolation
Not too much alcohol

140
Q

What is the role of an orthogeriatrician?

A 
Comprehensive geriatric assessment
Pre-operative assessment
Post-operative care
Facilitate early rehabilitation
Facilitate early supported discharge
Communication - with patient, relative, friends, and carers
141
Q

What happens in a geriatric assessment?

A 
Functional status
Cognitive status
Medical problems/co-morbidities
Geriatric syndromes
Medications
Nutritional status
Social issues eg social support, finances, accomodation
142
Q

What happens in a pre-operative assessment?

A

Assess severity of co-morbidities
Medications review and analgesia
Optimise to prevent delay to theatre
Escalation and resuscitation decisions

143
Q

What is the delirium assessment called and what does it assess for?

A

4AT
Alertness
AMT4 - ask the following - age, DOB, name of hospital, current year
Attention - list months of year backwards
Acute change or fluctuating course

144
Q

How can you prevent delirium?

A

Ensure adequate CNS O2 delivery
Correct any hypoperfusion, hypoxaemia, anaemia
Maintain normal fluid and electrolyte balance
Treat any fluid overload or dehydration
Treat with analgesia appropriately through appropriate route
Deprescribe any unnecessary or harmful medications
Ensure bladder and bowel function
Adequate nutritional intake
Proper position for meals
Nutritional supplements
Detect and treat and major complications
Ensure appropriate environmental stimuli
Reassurance
Early rehab and mobilisation

145
Q

When should you administer analgesia in a hip fracture?

A

Immediately
Assess within 30 mins of initial analgesia
Hourly on ward
Assess pain regularly to allow for movement, nursing care, and rehab
At times of routine nursing obs

146
Q

What analgesia should you give for a hip fracture?

A 
Fascia iliaca nerve block
Paracetamol
Opioids (+laxative) at lowest effective dose
- Buprenorphine patch
- Dihydrocodeine or oxycodone
Avoid NSAIDs/nefopam
147
Q

What is the primary prevention of osteoporosis?

A

FRAX

If < 70 request DEXA

148
Q

What is the secondary prevention of osteoporosis?

A 
Non-pharmacological
- Weight bearing exercises and muscle strengthening
- Falls prevention
- Smoking cessation and avoid alcohol
Pharmacological
- Calcium and vit D replacement
- Bisphosphonates
149
Q

What is important to remember when prescribing bisphosphonates?

A

Ensure no serious dental issues (risk of osteonecrosis of jaw)
CI if CrCl < 30ml/min
PO if probability > 1% unless GORD/PUD
IV if probability > 10%

150
Q

What is delirium?

A

Acute confusional state that fluctuates in severity and usually reversible, usually result of other organic process
1/3 will resolve quickly
1/3 will recover but much more slowly
1/3 will not recover to baseline

151
Q

What is dementia?

A

Syndrome of acquired. chronic, global impairment of higher brain function, is an alert patient, which interferes with ability to cope with daily living
Decline in memory with impairment of at least one other cognitive function such as skilled movements, language or executive function

152
Q

What is BPSD?

A

Behavioural and psychological symptoms of dementia - heterogenous group of non-cognitive symptoms and behaviours eg agitation, irritability, depression, disinhibition, hallucinations

153
Q

What are the symptoms of hyperactive delirium?

A 
Agitation
Delusions
Hallucinations
Wandering
Aggression
154
Q

What are the risk factors for delirium?

A 
Old age
Dementia
Past H/0 delirium
Significant co-morbidities
Sensory impairment
Change of environment
155
Q

What are the causes of delirium?

A

PINCH ME

  • Pain
  • Infection
  • Nutrition
  • Constipation
  • Hydration
  • Medication
  • Environment

DELIRIUM

  • Drug - introduction or adjustments
  • Electrolyte and physiological imbalances
  • Infection
  • Reduced sensory input
  • Intracranial problems
  • Urinary retention and constipation
  • Myocardial problems
156
Q

How do you manage hyperactive delirium?

A 
Non-pharmacological first line
- Orientation, reassurance
- Continuity of care - staff/environment
Sedation may be required if at risk to themselves or others
Use lowest possible dose
Usually quite reversible
157
Q

What are causes of a reversible dementia?

A 
Depression
B12/folate
Hypothyroid
NPH
Substance misuse
SLO
Syphillis
158
Q

What are the symptoms of hypoactive delirium?

A 
Lethargy
Slowness with everyday tasks
Excessive sleeping
Inattention
Can be confused with depression
159
Q

What are the complications of delirium?

A

High risk of death if untreated

Hypoactive has higher risk

160
Q

What is a TIA?

A

Neurological dysfunction caused by focal brain, spinal cord, or retinal ischaemia without evidence of acute infarction with symptoms lasting less than 24 hours

161
Q

What is the risk of stroke following a TIA?

A

At 2 days
- 2-4.1%
At 7 days
3.9-6.5%

162
Q

What treatment should you start with TIA immediately?

A

Aspirin and refer to TIA clinic

163
Q

What should influence the speed of your referral to TIA clinic?

A

ABCD2 score

164
Q

What investigations should you do following a TIA?

A 
Bloods - FBC, WCC, U&E, CRP/ESR, LFTs, TFTs, haematinics
ECG
USS carotid
Brain imaging
Consider ECHO
Consider 24 hr vs 72 hours tape
165
Q

What is a stroke?

A

Clinical syndrome characterised by sudden onset of rapidly developing or focal or global neurological disturbance which lasts more than 24 hours or leads to death, with no apparent cause other than that of vascular origin

166
Q

What are the 2 types of stroke and how common are they?

A

Ischaemic - 85%
Haemorrhagic
- Primary 10%
- SAH 5%

167
Q

What are the differentials of stroke?

A 
Migraine
SDH
Cancer
Infection
Hypoglycaemia
Seizure
PRES
Functional
168
Q

What are the causes of an ischaemic stroke?

A

Atherosclerosis
Cardio-embolism
Dissection

169
Q

What imaging should you do for a stroke?

A

Within 1 hour
CT head
MRI

170
Q

What is the management of an ischaemic stroke?

A 
Short term
- Anti-platelets
- Manage BP + acute management keep BP < 220/110 unless end organ damage
- Thrombolysis
- Thrombectomy
- Endartectomy
Long term
- Lifestyle - salt, exercise, smoking, alcohol
- Lipids aim to reduce by 40%
- BP long term 130/80
Driving none for 1 month
171
Q

What is carotid endarterectomy?

A

Unblocking carotid
Reduce 5 year absolute risk of ipsilateral ischaemic stroke by 16% in patients with 70-99% stenosis
Many risks associated

172
Q

What is thrombolysis?

A 
Use of drugs to break up clot
Considered if present within 4.5 hours
Number of CI
- High BP > 185/110
- Blood thinners
- Bleeding
- Major surgery
- Unconfirmed stroke
173
Q

What is mechanical thrombectomy?

A

Use of catheter fed up into brain to aspirate clot or remove
Indications
- Proximal intracranial large vessel occlusion
- Causing disabling neurological deficit
- Procedure can begin within 5 hours of known onset

174
Q

What causes haemorrhagic strokes?

A 
Cerebral amyloid angiopathy
HTN
Aneurysms
AVMs
Trauma
Blood thinners
175
Q

What is the management of haemorrhagic strokes?

A

BP management 140/80
Reverse anticoag
Neurosurg referral
If develop hydrocephalus consider insertion of external ventricular drain

176
Q

What is frailty?

A

Distinct health state characterised by reduction in physiological reserve syndrome characterised by sudden onset of rapidly developing or focal or global neurological disturbance which lasts more than 24 hours or leads to death, with no apparent cause other than that of vascular origin
Evidence linking frailty with mortality

177
Q

What are the different methods of scoring frailty?

A

Phenotype - Fried

Cumulative deficit - FI, CFS

178
Q

What is the fried criteria for frailty?

A 
Description of a phenotype
Clinical syndrome of >  3 of
 - Unintentional weight loss
- Self-reported exhaustion
- Weakness (grip strength)
- Slow walking speed
- Low physical activity
If 2 then pre-frailty
179
Q

What does the Fried criteria predict?

A

Independently predictive over 3 years of incident falls, worsening mobility or ADL disability, hospitalisation, and death

180
Q

What is the clinical frailty scale?

A

Overall trend of increasing mortality with increasing frailty
Not validated for measuring improvement in individuals after acute illness or for < 65
Practicality uses eg assessment for ITU admission suitablity

181
Q

What is the e-FI3?

A

Calculated by presence of absence of individual deficits as a proportion of 36 total possible deficits
Mixture of co-morbidities, self reported symptoms and social factors
Robust predictive validity for outcomes of 1, 3 ,and 5 year mortality, hospitalisation, and nursing home admission

182
Q

What is palliative care?

A

Treatment recognises irreversible nature of underlying disease process - holistic approach, symptoms control
Disparity of access to palliative care for frail patients
Benefit of palliative care is avoid futile treatment

183
Q

What is end of life care?

A 
Last 12 months
Disease relentless
Frailty predictor of mortality
Unpredictable
Irreversible frailty/decline should prompt discussion re end of life
184
Q

What could advance care planning include?

A 
Legal aspects
Preferred place of care
Treatment options acceptable to patient and suitable for patient
DNAR
Specific plan for complex scenarios
185
Q

What are the advantages of advanced care planning?

A

Open ended
Personalised care - planning/stating preferences
Avoids futile disease orientated treatment
Patient-centred goals
Improves co-ordination of care

186
Q

What is the role of a registered dietician?

A

Only qualified health professional that assesses, diagnoses and treats dietary and nutritional problems
Works closely with MDT and covers a range of settings
Therapeutic diets
Improving nutrition
Diagnosing nutritional problems
Advising on feeding routes
Advising on refeeding syndrome management
Creon adjustments

187
Q

How common is malnutrition?

A

35% patients admitted to hospital at risk of malnutrition
70% patients weigh less on hospital discharge
Affects over 3 million people in UK
Cost 19.6 billion per year

188
Q

What are the causes of malnutrition?

A

Decreased nutrient intake (starvation)
Increased nutrient requirements (sepsis or injury)
Inability to utilise nutrients ingested (malabsorption)
Or combination

189
Q

What are the consequences of malnutrition?

A 
Weakened immune system
Muscle wasting - increased falls, chest infection, decreased mobility/inactivity
Impaired wound healing
Micronutrient deficiencies
Poorer prognosis
Reduced QOL
Increased length of stay
Increased complications
More re-admission
Greater healthcare needs in community
190
Q

What is MUST?

A

Malnutrition universal screening tool
Scores based on BMI, history of weight loss, acute disease effect
Allows for development of care plan and monitoring
BMI
% unplanned weight loss
Acute disease effect and score - acutely ill and has been or likely to be no nutritional intake for > 5 days
If score 2 or more - high risk so treatF

191
Q

How do you treat malnutrition?

A

Food first
Oral nutritional supplements
Enternal/parenteral nutrition

192
Q

What oral nutritional supplements are used?

A

Liquid/powder/semi solid
Macro/micronutrients
Milkshakes, juice, soup, semi solid, high energy powders, high protein, low volume/high concentration
Mainly sweet

193
Q

What is the IDDSI?

A

International dysphasia diet standardisation initiative
SLT recommended
Dysphasia - ensure feeding is in line with IDDSI
Need different textures for different abilities to swallow or can lead to asphyxiation

194
Q

What is enteral nutriton?

A

Direct feeding into gut such as stomach/duodenum/jejunum
Preserves gut mucosa and integrity
Inexpensive compared to parenteral nutrition

195
Q

What are the disadvantages of enteral nutrition?

A

Tolerance levels eg nausea, satiety, bowel function
Tube can be uncomfortable
QoL, personal appearance

196
Q

What are the routes of enteral feeding?

A

NG - feeds into stomach, inserted at ward level, for short term use < 30 days, gold standard check pH aspirate, second line confirmation x-ray
NJ - feeds into jejunum, short term use < 60 days, radiologically guided, can only check position with x-ray

197
Q

What are long term forms of enteral feeding and what are the indications for each?

A

PEG - dysphasia, CF, oral intake inadequate and likely to be long term
Post pyloric/PEJ/surgical JEJ - delayed gastric emptying, upper GI/pancreatic surgery, high risk of aspiration, severe acute pancreatitis

198
Q

What is parenteral nutriton?

A

Feeding IV when gut is inaccessible or unable to absorb sufficient nutrition to sustain nutritional status

199
Q

What are the indications for parenteral nutrition?

A

Inadequate absorption
GI fistula
Bowel obstruction
Prolonged bowel rest
Severe malnutriton, significant weight loss and/or hypoproteinaemia when enteral therapy not possible
Other disease states or conditions in which oral or enteral feeding is not an option

200
Q

What are the methods of giving parenteral nutrition?

A

PICC line or central line

201
Q

What are the advantages of parenteral nutrition?

A

Helpful to meet nutritional requirements and promote recovery if used appropriately
Easily tolerated

202
Q

What are the disadvantages of parenteral nutrition?

A

More costly than enteral
Risk of infection
More invasive procedures
Gut atrophy

203
Q

What is refeeding syndrome?

A

Group of clinical symptoms/signs that can occur in malnourished/starved patient when reintroducing nutrition
Shift in use of energy stores from fat metabolism to carbohydrate metabolism
Initiates insulin increase and cellular uptake of potassium, phosphate, and magnesium
Shifts in fluid and electrolytes

204
Q

What are the results of refeeding syndrome?

A

Fluid retention
Cardiac arrhythmias
Respiratory insufficiency
Death

205
Q

What is the treatment of refeeding syndrome?

A

IV pabrinex or thiamine + vit B co-strong to feeding and for first 10 days
STH refeeding syndrome guidelines
Slow reintroduction of nutrition
Daily monitoring of refeeding bloods including U&Es, PO4, Mg and correct as necessary

206
Q

What are the differences between dementia and delirium?

A

Delirium has a sudden and severe onset, it is a brief episode, reversible, fluctuating consciousness, disorganised conversation, altered sleep-wake cycle
Dementia is irreversible, increasing loss of cognition and brain function, alert, engages well, altered sleep wake cycle

207
Q

What are the symptoms of delirium?

A 
Mood changes
Changes in speech
Sleep changes
Disorientation and confusion
Visual hallucinations (hyper)
Physical issues
208
Q

What are the symptoms of dementia?

A 
Memory loss
Difficulty with ADLs
Changes in mood
Changes in ability to problem solve
Increasing difficulty focussing or paying attention
Changes to personality
209
Q

What is the relationship between delirium and dementia?

A

Interrelationship
People with dementia more likely to develop delirium and people with multiple episodes of delirium are more likely to develop dementia

210
Q

What are the different types of dementia?

A

Alzheimer’s disease
Vascular dementia eg stroke (step-wise decline)
Parkinson’s disease
Dementia with lewy body (Parkinsonism features)
Frontotemporal dementia (disinhibition, progressive aphasia)
Severe head injury

211
Q

How do you assess mental state?

A 
History
- Collateral
- Onset
- DHx, FHx
- Effect on ADLs
- CVS/previous delirium/TIA/stroke
- Symptoms
- SHx - smoking/alcohol
General examination
- Chest, HS, ect
- Parkinsonism features
MMSE
AMT
212
Q

What investigations should you do in a confusion screen?

A 
FBC
U&E
LFT
Ca
CRP
213
Q

What investigations should you do in dementia screen?

A 
TSH
B12
Folate
FBC
LFT
U&E
ESR/CRP
Syphillis serology
Glucose
214
Q

What should you do for someone under 50 with dementia symptoms?

A

Syphilis serology

HIV screen

215
Q

How is dementia managed?

A

Medications
- Acetylcholinesterase inhibitors eg rivastigmine or donepezil
- Mmeantine for severe dementia 12/less on MMSE
Cognitive stimulation therapy
Cognitive rehabilitation
Reminiscence and life story work

216
Q

How does geriatric medicine differ from medicine for younger people?

A

More co-morbidities leading to polypharmacy
Social issues so complex discharges
Different atypical presentations
Difficult to take histories - confusion, contralateral histories
Ethical issues - high degree of mortality
Slower response to treatment
Non-specific signs and symptoms - longer admission, MDT involvement
Silent issues - MI, PUD

217
Q

What are the 6I’s of geriatric giants?

A 
Instability (falls)
Infirmity (confusion)
Incontinence
Immobility
Inanition (frailty)
Iatrogenic (polypharmacy)
218
Q

How is activity of daily living assessed?

A

Review with occupational therapists

Barthel index

219
Q

What does the Barthel index assess?

A 
Feeding
Bathing
Grooming
Dressing
Bowels
Toilet use
Transfers
Mobility
Stairs
220
Q

What is polypharamacy?

A

Regular use of at least 5 medications

221
Q

Why is polypharmacy more likely to occur in older people?

A

Need to treat various disease states that develop with age
More likely to have multiple conditions that need treating or conditions that require multiple medications to treat
Drs often over prescribe

222
Q

What is the affect of aging on pharmacokinetics?

A

With age, increased body fat, and total body water decreased. Increased fat increased volume of distribution of highly lipophilic drugs
Increased water decreases volume of distribution of highly hydrophilic drugs
Hepatic metabolism of many drugs through cytochrome P-450 enzyme decreases with age - first pass metabolism decreased
Decreased renal elimination of drugs
Decreased albumin so less drug bound to it - less distribution
Absorption is not affected

223
Q

What is the effect of aging on pharmacodynamics?

A

Effects of similar drug concentrations at the site of action may be greater or smaller than those in younger people
Due to changes in drug-receptor interaction, in post-receptor events, or in adaptive homeostatic responses and among frail elderly often due to pathological changes in organs
Response depends on specific drugs eg increased anti-cholinergic drug effects and hypoglycaemic drugs
Most drugs have increased effect

224
Q

What are the complications of polypharmacy?

A

Increased risk of adverse drug events
Increased risk of drug interactions
Increased risk of medication non-adherence
Reduced function capacity
Multiple geriatric syndromes - cognitive impairment, falls, incontinence
Increased healthcare costs

225
Q

How can polypharmacy be avoided?

A

Reviewing doses
Elimination duplicate medications
Assessing for drug-drug interactions
Removing medications that aren’t required

226
Q

Why should you stop NSAIDs in the elderly asap?

A

Worsen kidney function
Increased risk of GI bleeding
Increased risk of CVS events

227
Q

When should you stop clopidogrel after an MI?

A

12 months

228
Q

What should you prescribe after an MI?

A

Aspirin 300mg

Clopidogrel in adults over 76 - 75mg

Neuro and geriatrics (21 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions