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Finals > Frailty > Flashcards

Frailty Flashcards

1
Q

what is frailty

A

a state of increased vulnerability resulting from ageing

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2
Q

what scores on the Rockwood Clinical Frailty Scale indicate death within 6 months

A

7-9

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3
Q

at which point on Rockwood is the px completely dependent for personal care?

A

7 - severely frail

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4
Q

frailty, disabiility and X overlap

A

multimorbidity

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5
Q

what is the issue with strictly following guidelines with patients with frailty and multimorbidity?

A

dont provide guidance on multimorbidity so need to use clinical judgement

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6
Q

what is multimorbidity?

A

co-existence of 2+ chronic conditions where 1 is not necessarily more central than others w disctinctive cumulative effects for each px

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7
Q

what is multimorbidity assoc with?

A

inc rate of death, disability, AEs, use of healthcare resources, dec QoL

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8
Q

comorbidities can be divided into what 3 groups

A

clinically dominant
synegistic
coincidental

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9
Q

what is an example of a clinically dominant comorbidity

A

dementia trumps heart disease

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10
Q

what is an example of a synergistic comorbidity

A

COPD and heart disease

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11
Q

clinical reasoning and X are essential to managing comorbidity

A

shared decision making.
weight risks and benefits

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12
Q

what is the pathophysiology of frailty

A

increasing sarcopenia with age, loss of function and reduced physiological reserve. vulnerability can lead to sudden deterioration

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13
Q

what are the 5 frailty syndromes?

A

instability, immobility, delirium, incontinence, susceptibility to SE

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14
Q

give examples of susceptibility to SE of meds

A

confusion w codeine
hypotension w antidepressants

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15
Q

how to communicate frailty, avoid what?

A

labelling

say things like it can take longer to bounce back and vulnerability, lack of robustness, lack of resilience (dont sau complex sitch)

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16
Q

what score of the EFS means that a patient needs a full MDT assessment to prevent frailty?

A

5

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17
Q

what are the 2 comprehensive geriatric assessments to assess frailty

A

AMT
EFS

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18
Q

aim of comprehensive geriatric assessment

A

to make a coordinated integrated plan for Tx and long term support

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19
Q

what to ask px for EFS

A

on 5+ meds on regular basis
adherence + concordance
….

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20
Q

what interventions can we make for frailty?

A

med revs, identify and reverse diagnoses, nutritional support, exercises, home first

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21
Q

patients with a higher CFS are twice as likely to experience an ADR, true or false

A

true - frailty linked with increased risk AE

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22
Q

5 main reasons of problematic pharmacy

A
  • no evidence based indication
  • meds prexc to treat SE of other meds
  • meds fail to acheive therap obj
  • meds cause unacceptable ADRs
  • demands of med taking are unacceptable to px/ px cant maintain adherence
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23
Q

what are some of the worst tolerated meds in frailty?

A

NSAIDS,
long acting benzos,
sulphonylureas,
anticholinergics,
sedatives,
hypnotics

24
Q

what is the prescribing cascade

A

when ADR is misinterpreted as a medical condition and new medicines are started

25
Q

what is the prescribing vortex

A

when each medication causes a SE that is caused by the next

26
Q

give an example of presc vortex with oral bisphosphonate at start

A

oral bisphosp -> GI SE -> PPI -> increased fracture risk -> back to start

27
Q

is increased ACB (anticholinergic burden) score associated with increased morbidity

A

yes

28
Q

what score on the ACB means that a MAP review is needed
(meds, alternatives, px monitoring)

A

3

29
Q

name 6 anticholinergic SEs

A

urinary retention
dry throat, mouth, constipation
feel hot, sweat
tachcardia
blurry vision, dry eyes
sedation, dizzy, confusion

30
Q

What is MAP

A

medicines - is it essential
alternatives
patient monitoring - symptoms and SE

31
Q

name 2 meds w highest ACB score

A

amitryptyline
chlorphenamine

32
Q

what should be avoided with NSAIDs as they are high risk combinations?

A

ACEi/ARB, existing renal disease, HF, warfarin, no PPI and age over 75

33
Q

what are high risk combinations with warfarin

A

antiplatelet (some exceptions), NSAID, macrolide, quinolone, metronidazole, azole antifungal

34
Q

if someone has HF, what should be avoided

A

glitazones, NSAIDs, tricyclic antidepressants

35
Q

which drugs are associated with rapid symptomatic decline if stopped or require cautious stepwise withdrawal

A

ACEi in HF, diuretics in HF, rate/rhythm control, opioids, antidepressants. antipsychotics, antiepileptics

36
Q

what is delerium caused by

A

acute illness or drug toxicity, often reversible and affects attention

37
Q

pts with dementia are not at increased risk of delirium, true or false

A

false

38
Q

what condition: typically caused by anatomic changes in brain, slower onset, generally irreversible and affects memory

A

dementia

39
Q

2 diagnostic tools for delirium

A

AMT
CAM

40
Q

Pinch me acronym - causes of delirium

A

pain, infection, nutrition, constipation, hydration, medication, environment

41
Q

what is hyperactive delirium

A

heightened arousal, restless, agitated, aggressive

42
Q

what is hypoactive delirium

A

apathy, quiet confusion
often confused w depression

43
Q

Who is at risk of falling?

A

visual impairment, cognitive impairment, physically frail, alcohol, mutilple meds, fear of falling

44
Q

multifactorial falls risk assessment may include what?

A

identification of falls hx
assess gait, balance, mobility, muscle weakness
OP risk
visual impairment
urinary incontinence
…

45
Q

how to measure a postural BP

A

lie for 5 mins then measure
when standing measure at 1,3 and 5 mins
remain standing!

46
Q

postural hypotension = inability to maintain BP on upright position from supine, leading to drop of what mmHG?

A

at least 20/10 drop

47
Q

important risk factors of post hypo

A

ageing (assoc w physical deconditioning)
meds affecting sympathetic tone (tamsulosin, antihypers, antideppressants SSRIs TCAs)
dehydration

48
Q

what is reflex tachycardia

A

blood pressure lowers and the body compensates by increasing HR which increases blood pressure

49
Q

which medicines cause postural hypotension

A

diuretics
nitrates
sildlenafil
ethanol
levodopa
TCA antideps
SSRIs
anti epileptics carbamazepine
anti psycho
anti musc
opiates

50
Q

what is diabetes HbA1C target for someone with an advanced stage of frailty

A

over 70mmol/L
(use clinical judgement)
CFS 8, will pass away in next 6 months

51
Q

should aspirin be used for primary prevention

A

no

52
Q

lifestyle advice for postural hypotension

A

2L water, increase salt intake, get up slowly and clench muscles, not take hot baths, drink caffeinated drinks

53
Q

pharmacological management of postural hypotension

A

fludrocortisone, midodrine

54
Q

why must you not start risperidone/lorazepam in acute delirium in the elderly

A

increased fall risk

55
Q

why is lactulose not a great choice for constipation

A

need lots of water to make it work and can cause abdominal discomfort

56
Q

why should constipation be treated in the elderly

A

can lead to cognitive impairment and urinary retention

57
Q

why would you not start a bisphosphonate in a pt with a CFS score of 7

A

Finals (30 decks)

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