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Year 6 > Geris > Flashcards

Geris Flashcards

1
Q

first line medication for delirium/acute confusional state

A

haloperidol

shorter half life than Benzos

avoid in Parkinsons patients: use lorazepam instead

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2
Q

2nd line treatment for Alzheimers dementia

A

Memantine

glutamate receptor antagonist

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3
Q

what is an advanced decision?

legally binding?

A

An Advanced Decision, short for Advanced Decision to Refuse Treatment, is a legally binding document. Its purpose is to ensure that an individual can refuse a specific treatment(s) that they do not want to have in the future.

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4
Q

what is an advanced statement?

legally binding?

A

An Advance Statement is sometimes called a “Statement of Wishes and Care Preferences”. It allows an individual to make general statements about their wishes, beliefs, feelings and values and how these influence their preferences for their future care and treatment

An Advanced Statement can be made verbally and not by itself legally binding, but legally must be taken into consideration when making a “best interests” decision on someone’s behalf under the Mental Capacity Act

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5
Q

what can an advanced decision not do?

A

refuse basic care like nutrition, daily care like washing and comfort treatment like painkillers

Also can’t request treatment

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6
Q

medication to treat restlessness and agitation in end-of-life patients.

A

midazolam in syringe driver

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7
Q

numerical definition of postural hypotension

A

> 20mmHg in systolic blood pressure or >10mmHg in diastolic blood pressure within 3 minutes of standing

sign of autonomic dysfunction

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8
Q

MoA of donepezil

A

increase ACh in the brain

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9
Q

condition characterised by hallucinations secondary to visual impairment

A

Charles Bonnet Syndrome

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10
Q

imaging findings most likely to be associated with vascular dementia

A

white matter hyper intensities on MRI

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11
Q

CAM diagnostic criteria for delirium [4]

A

1) acute onset with fluctuating course
2) inattention
3) disorganised thinking
4) altered level of consciousness.

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12
Q

drugs that lower seizure threshold

A

Drugs
Asthma:
Pysch: Antipsychotics, Bupropion, Venlafaxine
Antibiotics: Imipenem, penicillins, cephalosporins, metronidazole, isoniazid
NSAIDs: mefanmic acid
Opiates: Tramadol

Fentanyl
Ketamine
Lidocaine
Lithium
Antihistamines

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13
Q

features of Lewy Body Dementia

A

presence of dementia alongside two of the three core features:
- fluctuating attention and concentration
- recurrent well-formed visual hallucinations
- spontaneous Parkinsonism

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14
Q

drug that may be used to treat postural hypotension [2]

A

midodrine (alpha 1 agonist)

fludrocortisone (SE of mineralocorticoids is hypertension)

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15
Q

MoA of carbidopa

A

peripheral decarboxylase inhibitor

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16
Q

central side effects of L-Dopa

A

Central side effects include:

Hallucinations
Confusion
Dyskinesia
Psychosis

17
Q

peripheral side effect of L-Dopa [2]

A

Postural hypotension
Nausea & vomiting

NV treated with domperidone

18
Q

Causes of orthostatic hypotension [6]

A
  • Medications, particularly vasodilators, diuretics, negative inotropes, antidepressants, and opiates
  • Chronic hypertension due to the loss of baroreceptor reflexes
  • Dehydration
  • Sepsis
  • Autonomic nervous system dysfunction, such as Parkinson’s disease
  • Adrenal insufficiency
19
Q

what medication should be avoided in Lewy body Dementia

A

Neuroleptics

20
Q

__________ are associated with a significant increase in mortality in dementia patients

A

Antipsychotics are associated with a significant increase in mortality in dementia patients

21
Q

Grade 1 Waterlow

A

Non-blanchable erythema of intact skin. Discolouration of the skin, warmth, oedema, induration or hardness may also be used as indicators, particularly on individuals with darker skin

22
Q

Grade 2 Waterlow

A

Partial thickness skin loss involving epidermis or dermis, or both. The
ulcer is superficial and presents clinically as an abrasion or blister

23
Q

Grade 3 Waterlow

A

Full thickness skin loss involving damage to or necrosis of subcutaneous tissue that may extend down to, but not through, underlying fascia.

24
Q

Grade 4 Waterlow

A

Extensive destruction, tissue necrosis, or damage to muscle, bone or
supporting structures with or without full thickness skin loss

25
Q

treatment of pressure sores

A

Hydrocolloid dressings and hydrogels

26
Q

screening tool for identifying medications where the risk outweighs the therapeutic benefits in certain conditions

A

STOPP

27
Q

screening tool for identifying medications that may provide additional benefits ie proton pump inhibitors for gastroprotection in patients on medications increasing bleeding risk

A

START

28
Q

what screening tool can be used to assess frailty

A

PRISMA-7

29
Q

difference between LBD and Parkinsons dementia

A

in LBD features of Parkinsonism tend to manifest at the same time or after the onset of dementia, in contrast to Parkinson’s disease dementia which presents after 1 year of parkinsonian symptoms.

30
Q

what part of the brain is atrophied in Alzheimers

A

cortex and hippocampus

31
Q

what part of the brain is atrophied in Parkinsons

A

basal ganglia and substantia nigra

32
Q

features of LBD

A

progressive cognitive decline incl short term memory loss
fluctuating cognition incl intermittent confusion
early impairments in attention and executive function
Parkinsonism later
visual hallucination

33
Q

diagnosis of LBD

A

usually clinically

single-photon emission computed tomography increasingly used (SPECT aka DaTscan)

34
Q

what drug is used in acute confusional state for patients with Parkinsons

A

IM lorazepam

35
Q

first line investigations for dementia in primary care and secondary care

A

blood screen is usually sent to exclude reversible causes (e.g. Hypothyroidism). NICE recommend the following tests: FBC, U&E, LFTs, calcium, glucose, ESR/CRP, TFTs, vitamin B12 and folate levels.

referral to memory clinic

secondary care: neuroimaging to see what subtype of dementia

36
Q

which of the following can a GP NOT use:
- GPCOG
- AMTS
- MMSE

A

AMTS

Year 6 (19 decks)

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