Elderly care

Question 1

What is a key consideration when prescribing medications for elderly patients?

Answer 1

Elderly patients often have polypharmacy, altered drug metabolism, and increased sensitivity to side effects

Question 2

What should be reassessed after administering IV fluids to elderly patients?

Answer 2

Fluid status (e.g., BP, urine output, JVP, lung auscultation)

Question 3

What is the first-line fluid for maintenance in elderly patients unable to eat or drink?

Answer 3

0.9% NaCl + 20mmol KCl per 1L OR 5% Dextrose + 20mmol KCl

Question 4

What is the recommended rate for maintenance fluids in elderly patients?

Answer 4

25-30mL/kg/day (reduce to 20-25mL/kg/day if frail)

Question 5

What is the first-line fluid for resuscitation in shock or dehydration in elderly patients?

Answer 5

500mL Hartmann’s OR 0.9% NaCl

Question 6

What should be done after each bolus of IV fluids?

Answer 6

Reassess fluid status

Question 7

What is the first-line medication for managing chronic constipation in elderly patients?

Answer 7

Ispaghula husk (Fybogel)

Question 8

What is the recommended dose for Ispaghula husk?

Answer 8

1 sachet BD with fluids

Question 9

What type of laxative should be avoided in frail or dehydrated elderly patients?

Answer 9

Bulk-forming laxatives

Question 10

What is the first-line medication for opioid-induced constipation?

Answer 10

Macrogol + Senna

Question 11

What is the recommended dose for Macrogol in opioid-induced constipation?

Answer 11

1-2 sachets BD

Question 12

What should be avoided when prescribing NSAIDs to elderly patients?

Answer 12

Due to renal, GI, and cardiovascular risks

Question 13

What is the first-line drug for mild pain in elderly patients?

Answer 13

Paracetamol

Question 14

What is the recommended dose for Paracetamol?

Answer 14

1g QDS

Question 15

What should be considered if pain is not controlled in elderly patients on opioids?

Answer 15

Consider opioid patch

Question 16

What is the first-line medication for mild-moderate Alzheimer’s?

Answer 16

Donepezil

Question 17

What is the initial dose for Donepezil?

Answer 17

5mg OD

Question 18

What is the preferred SSRI for treating depression in elderly patients?

Answer 18

Sertraline

Question 19

What is the initial dose for Sertraline?

Answer 19

25mg OD

Question 20

What should be done with Metformin if eGFR is less than 30?

Answer 20

Stop Metformin

Question 21

What is a key guideline for prescribing to elderly patients?

Answer 21

Start low, go slow

Question 22

What should be monitored before prescribing nephrotoxic medications?

Answer 22

Renal function

Question 23

What is the recommended dose for Oxycodone in elderly patients?

Answer 23

2.5mg PRN

Question 24

What type of depression medication helps with poor appetite and sleep?

Answer 24

Mirtazapine

Question 25

What is the maximum duration for using Risperidone in elderly patients?

Answer 25

Max 6 weeks

Question 26

What should be checked to prevent falls in elderly patients?

Answer 26

Vitamin D levels

Question 27

What is the first-line medication for Generalised Anxiety Disorder (GAD) in elderly patients?

Answer 27

Propranolol

Question 28

What is the recommended dose for Propranolol?

Answer 28

10–40mg BD

Question 29

What type of laxative is Macrogol?

Answer 29

Osmotic

Question 30

What is a risk associated with Amitriptyline in elderly patients?

Answer 30

Causes falls and confusion

Question 31

What should be done to reduce polypharmacy in elderly patients?

Answer 31

Regularly review medications

Question 32

What type of medication should be avoided for sleep needs in elderly patients?

Answer 32

Benzodiazepines