Falls + Drugs

Question 1

What in a patients history + investigations suggest Rhabdomyolysis?

Answer 1

Long lie
Tea coloured urine
Raised creatine kinase + myoglobin

Question 2

What is released into the blood stream in Rhabdomyolysis?

Answer 2

Myoglobin

Question 3

How can Rhabdomyolysis cause an AKI?
Is this pre-renal, intrinsic or post-renal cause?

Answer 3

Myoglobin is toxic to the kidneys
Intrinsic

Question 4

Define postural hypotension

Answer 4

A drop in BP that occurs within 3 mins of standing
>20mmHg systolic or >10mmHg diastolic

Question 5

Possible GI causes of a fall

Answer 5

Constipation
Diarrhoea
Abdominal pain

Question 6

Possible respiratory causes of a fall

Answer 6

Breathlessness
Cough

Question 7

Possible CVS causes of a fall

Answer 7

Chest pain
Palpitations

Question 8

Possible neurological causes for a fall

Answer 8

Confusion
Change in sensation
Abnormal movements

Question 9

Possible MSK causes for falls

Answer 9

Joint pain

Question 10

Possible genitourinary causes of falls

Answer 10

Dysuria
Frequency
UTI
Nocturia
Urinary incontinence

Question 11

Possible head and neck causes for a fall

Answer 11

Dizziness on moving head
Change in eyesight

Question 12

What is the drug class of diazepam?

Answer 12

Benzodiazepine

Question 13

Uses of diazepam

Answer 13

Anxiety disorders
Sedatives
Treat muscle spasms

Question 14

What is the mechanism of action of diazepam?

Answer 14

• Enhances GABA effects (inhibitory neurotransmitter)
• Has a calming effect on the brain

Question 15

How could a patient taking diazepam be at an increased risk of a fall?

Answer 15

Sedative effect > could make patient drowsy

Question 16

What drug class is amlodipine?

Answer 16

CCB - dihydropyridine

Question 17

What are the uses of amlodipine?

Answer 17

Hypertension
Stable angina

Question 18

What is the mechanism of action of amlopidine?

Answer 18

calcium channel blocker
- selective for peripheral vasculature
- inhibits Ca2+ influx to vascular smooth muscles
- causes vasodilation
- decreases peripheral vascular resistance + cardiac workload

Question 19

How could a patient taking amlodipine be at an increased risk of a fall?

Answer 19

Side effects of dizziness + lightheadedness
Risk of hypotension

Question 20

What class of drug is Olanzapine?

Answer 20

Antipsychotic

Question 21

Uses of Olanzapine

Answer 21

Schizophrenia
Bipolar disorder
Depression

Question 22

What is the mechanism of Olanzapine?

Answer 22

Blocks dopamine, histamine + Muscarinic receptors

Question 23

How could a patient taking Olanzapine be at an increased risk of a fall?

Answer 23

Side effects of drowsiness, dizziness + impaired coordination

Question 24

What is the class of drug of codeine?

Answer 24

Opioid agonist

Question 25

What are the uses of codeine?

Answer 25

Pain relief Cough suppression

Question 26

What is the mechanism of action of codeine?

Answer 26

- binds to opioid receptors in brain > alters perception to pain + suppresses cough reflex - CYP2D6 converts codeine > morphine > analgesic effect

Question 27

How could a patient taking codeine be at an increased risk of a fall?

Answer 27

Side effects of drowsiness, dizziness + impaired coordination

Question 28

What is the class of drug of oxybutynin?

Answer 28

Anti Muscarinic

Question 29

What are the uses of oxybutynin?

Answer 29

Urinary incontinence Urinary frequency or urgency Overactive bladder

Question 30

What is the mechanism of action of oxybutynin?

Answer 30

**antimuscarinic** - Blocks M3 receptors in bladder > stops Ach from binding > inhibits contraction of bladder - increased capacity + decreased involuntary contractions

Question 31

How could a patient taking oxybutynin be at an increased risk of a fall?

Answer 31

Side effects of blurred vision, constipation, dizziness + drowsiness

Question 32

What is the class of drug of tansulosin?

Answer 32

Alpha 1 adrenergic antagonist

Question 33

What are the uses of tamsulosin?

Answer 33

BPH treatment

Question 34

What is the mechanism of action of tamsulosin?

Answer 34

- **alpha 1A antagonist** - inhibits bindings of noradrenaline to prostate - causes prostate smooth msucle relaxation - improves urinary flow

Question 35

How could a patient taking tamsulosin be at an increased risk of a fall?

Answer 35

Side effects of dizziness, constipation, diarrhoea + postural hypotension

Question 36

Describe the baroreceptors response to increase in BP

Answer 36

- increase in afferent impulses to cardiovascular centre in medulla - increase in parasympathetic activity - decrease in sympathetic activity - causes vasodilation + decrease in CO - decrease in BP

Question 37

what are the types of syncope?

Answer 37

Neurally mediated Orthostatic hypotension Cardiac arrrhytmia Structural cardiopulmonary

Question 38

What is orthostatic hypotension?

Answer 38

Decrease in systolic BP 20mmHg

Question 39

Causes of cardiac arrhytmia syncope

Answer 39

abnormal heart rhythm + rate *e.g. tachycardia or bradycardia*

Question 40

When does vasovagal syncope occur?

Answer 40

Whe your ody reacts to certain triggers such as emotional distress Neurally mediated syncope