Geriatrics Flashcards
(17 cards)
What are the harms of opioids?
Death
Respiratory depression
Immune suppression: infection, wound healing
Dental caries
Opioid induced hyperalgesia
HPA axis suppression: low testosterone, sexual dysfunction, fluid retention, osteoporosis
What is the definition of delirium?
Clinical manifestation of acute encephalopathy
DSMV:
Disturbance in attention, cognition and awareness developing over a short period of time representing an acute change from baseline and fluctuates over the course of the day that is due to a physiological consequence of another medical condition and not better explained by a pre-existing condition
What are precipitants of delirium?
- Alterations in oxidative metabolism: hypoxia or hypoglycaemia/increased insulin resistance
- inflammation
- impaired neurotransmitter function from drugs or stress
How is polypharmacy defined?
The use of 5 or more medicines
What are common drugs and their ADRs that pose risk to older people?
- NSAIDs: GIB, renal impairment, HTN
-Benzos: falls
-AntiCh: urinary retention, cognitive impairment
-TCAs: postural hypotension, sedation
-Sulphonylureas: hypoglycaemia
-Prazosin: postural hypotension, dry mouth, urinary problems
What are the potential risks of the following drug-drug interactions in the elderly:
1. ACEi + diuretic
2. ACEi + potassium
3. Anti-arrhythmic + diuretic
4. Benzo + antidepressant, antipsychotic or benzo
5. CCB + diuretic or nitrate
6. Digoxin + antiarrhythmic
- hypotension, hyperkalaemia
- Hyperkalaemia
- Electrolyte imbalance, arrhythmia
- confusion, sedation, falls
- Hypotension
- bradycardia, arrhythmia
What are the key characteristics of dementia as a diagnosis?
Decline in cognitive function with impairment in 2 or more domains that interferes with persons performance of ADLs
What are the key features of Alzheimer’s dementia?
Clinical diagnosis, may have postive genetic test or family history
Insidious onset of memory impairment (+other domains)
Often accompanied with low mood and apathy
May feature aggression, abnormal gait
What are key features of vascular dementia?
Cognitive deficit has to be temporally associated with vascular event (ischaemic, haemorrhagic)
Mostly affects speed of information processing, complex attention, frontal executive functioning
What are key features of lewy body dementia?
Insidious onset primarily affecting attention and executive function
Accompanied by visual hallucinations and REM sleep disorder
May be followed by Parkinson symptoms (often 1 year after cognitive symptoms)
What are the 3 variants of fronto-temporal dementia?
Behavioural
Primary progressive aphasia
Motoric
What are the key features of behavioural variant of frontotemporal dementia?
-Personality change: apathy, innapropriate social behaviour
-Cognitive testing displays executive dysfunction with intact memory
What are the key features of primary progressive aphasia variant of frontotemporal dementia?
Impairment in language in the absence of other cognitive problems (memory in tact until late in disease)
- Logopenic = difficulties in single word retrieval, repetitive phrases
- semantic = loss of familiar objects, people, places
- agrammatic = poor grammar in written and spoken language
What are the key features of motoric variant of frontotemporal dementia?
Impairment in attention, executive functioning and visuspatial function with intact memory
May accompany supranuclear palsy, corticobasal degeneration, motor neurone disease
What medications can be used for dementia?
-Cholinesterase inhibitors approx 50% patients will derive benefit in symptoms but does not delay disease progression
- Memantine = NMDAR antagonist, improve cognitive function in moderate to severe AD
Cannot be used in conjunction
How should symptoms of dementia be managed?
Non-pharmacologically
What medications have evidence for symptom relief in dementia?
Analgesia for pain
SSRIs for agitation
Risperidone or olanzapine for severe distress
