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Geriatrics + Year 4 Recap > Geriatric Syndrome > Flashcards

Geriatric Syndrome Flashcards

Frailty, Falls, Dizziness, Delirium, Urinary Incontinence (65 cards)

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1
Q

What is the role of Cinnarizine in vestibular disorders?

What patient population is it used in caution in?

A

Increases cochlear circulation, but has antihistaminergic & antidopaminergic effects.

Caution: Avoid in PD patients (can worsen symptoms).

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2
Q

What is the 4 types of dizziness?

Dizziness

A

Vertigo, Pre-syncopal dizziness, Dysequilibrium, Unspecified dizziness

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3
Q

How does trauma contribute to delirium?

Delirium

A

Head injury, postoperative pain, and inflammation can trigger delirium.

Less impt

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4
Q

What is the usual dose of Haloperidol for general agitation?

Delirium

A

SC/IM/PO Haloperidol 0.3–1 mg BD, up to 5 mg/day (for non-ICU patients).

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5
Q

Name 2 classes of medication involved in hypoglycemia in FRID

Falls

A

Insulin, SUs

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6
Q

What does the mnemonic I WATCH DEATH stand for in delirium?

Delirium

A

It represents the common causes of delirium: Infections, Withdrawal, Acute metabolic disorder, Trauma, CNS pathology, Hypoxia, Deficiencies, Endocrinopathies, Acute vascular, Toxins, Heavy metals.

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7
Q

Which CNS pathologies can cause delirium?

Delirium

A

Stroke, hemorrhage, tumors, seizure disorders, Parkinson’s disease.

Less impt

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8
Q

What is a major downside of using benzodiazepines (e.g., Lorazepam) for agitation?

Delirium

A

May prolong delirium in elderly or medically complex patients.

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9
Q

Which first-generation antihistamines are used as vestibular suppressants?

Dizziness

A

Diphenhydramine, Dimenhydrinate, Meclizine.

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10
Q

Name two drug classes involved in sedation in FRID

Falls

A
  • Opioids
  • Anticonvulsants
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11
Q

How do α-blockers like tamsulosin affect urinary continence?

UI

A

Decrease urethral sphincter tone, leading to stress incontinence.

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12
Q

What is the geriatric syndrome of delirium?

Delirium

A

An acute neuropsychiatric disorder associated with medical conditions, medications, and/or substance intoxications or sudden withdrawal of psychoactive medications

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13
Q

Which substances can cause withdrawal-related delirium?

Delirium

A

Alcohol, barbiturates, benzodiazepines (sudden cessation can lead to withdrawal delirium).

Less impt

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14
Q

Which phenothiazines are used for dizziness and vertigo?

Dizziness

A

Prochlorperazine, Promethazine.

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15
Q

What are common causes of urge incontinence?

UI

A

Detrusor overactivity, local genitourinary conditions (e.g., tumors, stones, obstruction), and CNS disorders (e.g., stroke, Parkinson’s, dementia, spinal cord injury).

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16
Q

What does the mnemonic DIAPPERS stand for in UI?

A

Delirium → functional
Infection (acute UTI) → urge
Atrophic vaginitis → stress, urge
Pharmaceuticals
Psychological disorder (esp. depression) → functional
Excessive urine output (e.g. hyperglycemia) → urge
Reduced mobility (functional incontinence) or reversible UI (drug-induced)
Stool impaction (pseudodiarrhea) → overflow

Differential diagnoses

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17
Q

Which cardiovascular medications are considered FRIDs?

Falls

A

Beta-blockers, diuretics, and antihypertensives due to the risk of hypotension and dizziness.

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18
Q

Which type of incontinence is most associated with Parkinson’s disease?

UI

A

Urge incontinence, due to detrusor overactivity caused by impaired central nervous system control.

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19
Q

Why are phenothiazines contraindicated in Parkinson’s disease (PD), Parkinson’s disease dementia (PDD), and dementia with Lewy bodies (DLB)?

Dizziness

A

They have antidopaminergic effects, which can worsen Parkinsonian symptoms.

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20
Q

When should pharmacological management of agitation be used?

Delirium

A

Only as a last resort due to increased mortality and stroke risk in elderly dementia patients.

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21
Q

How does menopause contribute to stress incontinence?

UI

A

Decreased estrogen leads to weakened pelvic floor muscles and urethral sphincter dysfunction.

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22
Q

How does hypoxia lead to delirium?

Delirium

A

Anemia, cardiac failure, pulmonary embolism can decrease oxygen to the brain, leading to confusion.

Less impt

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23
Q

Which infections can cause delirium?

Delirium

A

Encephalitis, meningitis, urinary tract infections (UTI), pneumonia, intra-abdominal infections.

Less impt

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24
Q

Which antipsychotic is considered safest in terms of QTc prolongation?

Delirium

A

PO Olanzapine (ODT) 1.25–2.5 mg, up to 10 mg/day.

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25
What is the main side effect of first-generation antihistamines for dizziness? ## Footnote Dizziness
Strong anticholinergic effects → sedation, dry mouth, confusion (especially in elderly).
26
What are common causes of functional incontinence? ## Footnote UI
Severe dementia, neurologic disorders, depression, hostility, or mobility limitations preventing timely bathroom access.
27
Why should oral estrogens be avoided in UI, and what is the alternative? ## Footnote UI
Oral estrogens increase urinary incontinence – use topical estrogen for atrophic vaginitis instead.
28
Name 4 classes of medication involved in OH in FRID ## Footnote Falls
Α-blockers, central antihypertensives, vasodilators, diuretics
29
What is Betahistine used for, and when should it be avoided? ## Footnote Dizziness
* Used for chronic management of Meniere’s disease or persistent vertigo. * Caution in asthma/COPD. * C/I in active/history of peptic ulcer disease (PUD).
30
How do opioids affect bladder function? ## Footnote UI
Decreased bladder sensation and increased urethral sphincter tone, leading to urinary retention.
31
What are some serious etiologies of dizziness? (7) ## Footnote Dizziness
* Benign Paroxysmal positional vertigo * Orthostatic hypotension * Meniere Disease * Vestibular migraine * psychogenic dizziness * drug-induced dizziness * vestibular neuronitis
32
What is functional incontinence? ## Footnote UI
Urinary accidents due to inability to reach the toilet because of cognitive, physical, psychological, or environmental barriers.
33
What are the risks of using benzodiazepines for vestibular suppression? ## Footnote Dizziness
Short-term: Increased sedation & fall risk. Long-term: Cognitive impairment & depression.
34
Which vitamin deficiencies are linked to delirium? ## Footnote Delirium
Vitamin B12, folic acid, and thiamine deficiencies. | Less impt
35
What is the geriatric syndrome of falls? ## Footnote Falls
An unexpected event in which a person comes to rest on the ground, floor or lower surface
36
Prevention techniques of delirium (11) ## Footnote Delirium
* Sensory functions optimisations * Hydration/nutrition * Bowel movement/urination * Early mobility * Pain control * Medication review * Social interaction with loved ones * Reorientation with clock/ calendar/ proper lighting * Conducive environment * Promote good sleep * Address infection/ hypoxia | Impt!
37
What is overflow incontinence? ## Footnote UI
Leakage of small amounts of urine due to bladder overdistension or urinary retention affecting bladder/sphincter function.
38
What are common causes of stress incontinence? ## Footnote UI
Weak pelvic floor muscles (e.g., from childbirth, pregnancy, menopause), bladder outlet or urethral sphincter weakness, and post-urologic surgery.
39
How do benzodiazepines contribute to urinary incontinence? ## Footnote UI
Impaired micturition due to muscle relaxant effects.
40
When is Haloperidol contraindicated? ## Footnote Delirium
Prolonged QTc, Parkinsonism (including Dementia with Lewy Bodies [DLB] and Parkinson’s Disease Dementia [PDD]).
41
What is the geriatric syndrome of frailty? ## Footnote Frailty
Low physiologic reserves and is highly vulnerable to internal and external stressors
42
How does OH contribute to falls? ## Footnote Falls
Lower blood perfusion to brain (dizziness), legs (strength), and eyes (visual acuity) Fall risk ↑ when dehydrated
43
When is World Elder Abuse Day? ## Footnote Elder Abuse
15 June
44
Which endocrine disorders can cause delirium? ## Footnote Delirium
Thyroid dysfunction, hypoglycemia, parathyroid imbalances, adrenal disorders. | Less impt
45
What is the FRAIL Scale? ## Footnote Frailty
* Fatigue [Have you felt fatigue most of the time over the past month?] * Resistance [Do you have difficulty climbing 1 flight of stairs?] * Ambulation [Do you have difficulty walking one block/ 80m?] * Illness [> 5 conditions: Hypertension, DM, cancer, chronic lung disease, asthma, heart attack, CHF, angina, stroke, arthritis, kidney disease] * Loss of weight [Have you lost more than 5% of your weight in the past year?]
46
What is a Parkinson’s disease (PD)-friendly antipsychotic for agitation? ## Footnote Delirium
PO Quetiapine 6.25–12.5 mg BD, up to 100 mg/day.
47
What is a geriatric syndrome? ## Footnote Geriatric syndrome
Includes conditions that are: * Prevalent in the elderly patients * Impairments in multiple organ system * Negative impact on functional, quality of life and mortality
48
Which medication is used for agitation in alcohol or benzodiazepine withdrawal? ## Footnote Delirium
PO/IV/SC Lorazepam 0.5–1 mg.
49
How do anticholinergic drugs increase fall risk? ## Footnote Falls
They cause blurred vision, confusion, dizziness, and urinary retention, impairing mobility and balance.
50
Which drugs can cause nocturia due to edema? ## Footnote UI
Gabapentin, pregabalin, calcium channel blockers, thiazolidinediones, NSAIDs.
51
What are common causes of overflow incontinence? ## Footnote UI
Anatomic obstruction (e.g., prostate enlargement, stricture, cystocele), acontractile bladder (e.g., diabetes, spinal cord injury), neurogenic causes (e.g., multiple sclerosis), and medications.
52
Why should opioids be used cautiously in older adults? ## Footnote Falls
Opioids (e.g., morphine, oxycodone) cause drowsiness, dizziness, and impaired coordination, leading to a higher fall risk.
53
When should vestibular suppressants be used? ## Footnote Dizziness
Only if dizziness persists for more than 30 minutes. The medications often take > 30 min for onset of action, thus if the dizziness persists for < 30 min, not effective.
54
What are the 4 mechanisms of FRIDs | Fall risk increasing drugs ## Footnote Falls
1. Sedation 2. OH 3. Anticholinergics 4. Hypoglycemia
55
What is stress incontinence? ## Footnote UI
Involuntary loss of small amounts of urine due to increased intraabdominal pressure (e.g., coughing, laughing, exercise).
56
Which drug is used for nausea and vomiting associated with dizziness? ## Footnote Dizziness
Metoclopramide (alternative: Ondansetron).
57
Name 6 classes of medication involved in anticholinergic effects of FRID ## Footnote Falls
Antidepressants Antipsychotics Benzodiazepines Z-hypnotics 1st Gen Antihistamines Muscle relaxants
58
How can deprescribing help reduce fall risk in older adults? ## Footnote Falls
Stopping or reducing the dose of FRIDs can improve balance, cognition, and overall mobility, reducing the likelihood of falls.
59
Management of delirium ## Footnote Delirium
See formularies
60
What is Elder Abuse ## Footnote Elder Abuse
any action or inaction that puts the safety or well-being of an elderly persion at risk.
61
What acute metabolic disorders can lead to delirium? ## Footnote Delirium
Electrolyte imbalance, hepatic failure, renal failure. | Less impt
62
Which drug classes decrease bladder contractility due to anticholinergic effects? ## Footnote UI
Antimuscarinics, spasmolytics, anti-Parkinson’s agents, TCAs, and 1st/2nd gen antipsychotics.
63
Why should caution be used when prescribing antipsychotics in elderly patients with dementia? ## Footnote Delirium
Increases mortality and stroke risk, but does not improve quality of life (QoL).
64
What is urge incontinence? ## Footnote UI
Sudden leakage of urine (often large volumes) due to an inability to delay voiding after sensing bladder fullness.
65
Which antidepressant class increases urethral sphincter tone? ## Footnote UI
SNRIs (e.g., duloxetine, reboxetine).

Geriatrics + Year 4 Recap (9 decks)

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