Geriatrics Flashcards
(35 cards)
What is the first line sedative used in delirium
Treat underlying cause first and use de-escalating measures
Haloperidol 0.5mg
If they have Parkinson’s may need to reduce Parkinson’s meds slightly as antipsychotics can worsen parkinsonian symptoms
What are the different treatment options for Alzheimer’s disease?
Group cognitive stimulation and activities
Medications
1st line -Acetylcholinesterase inhibitors
Donepezil, galantamine and rivastigmine
2nd line - Memantine (NMDA receptor antagonist)
can also be an add on to 1st line if severe Alzheimer’s
Donepezil is contraindicated with bradycardia
Can also cause insomnia
What pathological changes are seen in Alzheimer’s
Widespread cerebral atrophy (cortex and hippocampus)
Beta-amyloid protein and intraneuronal neurofibrillary tangles
Tau protein
What is the management of dementia in primary and secondary care?
Primary care- blood screens exclude other causes (hypothyroid)- U&e, LFTs, Glucose, ESR/CRP, TFTs, B12 and folate
Secondary care- neuroimaging and memory clinic
What medications can cause postural hypotension
Nitrates
Diuretics
Anti-cholinergics
Antidepressants
B-blockers
L-dopa
ACE inhibit
What are the features of frontotemporal lobar dementia
Onset before 65
Insidious onset
Preserved memory and visuospatial skills
Personality change and social conduct problems
What are the features of Pick’s disease
Most common type of frontotemporal dementia
Personality change and social impairment
Increased appetite, disinhibition
Will show focal gyro atrophy with a knife blade appearance
Pick’s bodies present
What is semantic dementia
Fluent progressive aphasia
Fluent speech but makes no sense
Better memory for recent events instead of past
What are the features of Lewy Body dementia
Progressive cognitive impairment- happens before Parkinson’s- if it happens after then this is Parkinson’s with dementia
Flutuating cognition
Impaired attention and function rather than just memory loss
Parkinsonism
Visual hallucinations
Can give
Acetylcholinesterase inhibit and memantine
When should patients take a bisphosphate holiday
After 3 years
What are the predisposing factors to pressure ulcers
Malnourishment
Incontinence
Immobility
Pain
What scoring system is used to screen for pressure ulcer risk
Waterlow score
How are pressure ulcers graded
Grade 1 - non blanch erythema of skin - skin intact
Grade 2- Partial thickness of skin lost- epidermis and dermis or both- superficial- abrasion or blister
Grade 3- Full thickness - damage or necrosis of subcutwon’t go through the fascia
Grade 4- extensive necrosis with damage to muscle/ bone
What is the management of a pressure ulcer
Moist wound environment for healing - hydrocolloid dressings and gels
Only give abx if features of cellulitis
What are the features of vascular dementia
Risk factors
History of stroke, AF, HTN, DM, hyperlipidaemia, smoking, obesity, CHD, fam history
Presentation
Several months/ years of sudden or stepwise deterioration of cognitive function
Symptoms
Focal neuro issues- visual, sensory or motor symptoms
Seizures
Attention and concentration issues
Gait disturbance
Speech and emotion disturbance
What is the management of agitation and confusion in palliative care
Treat any underlying conditions
First choice- Haloperidol
Other options- chlorpromazine, levopromazine (antipsychotics)
If in terminal phase of illness give midazolam
What is the management of hiccups in palliative care
Chlorpromazine
Second line haloperidol and gabapentin
Dexamethasone if there are hepatic lesions
What are the 6 nausea and vomiting syndromes in palliative care
- Reduced gastric motility- opioids
- Chemically mediated- hypercalcaemia, opioids, chemo
- Visceral/ serosal- constipation/ candidiasis
- Raised ICP- cerebral mets
- Vestibular- acetylcholine and H1 receptors, opiod related, motion related or base of skull tumours
- Cortical- Anxiety, pain, fear/ anticipatory nausea
How is Nausea and vomiting treated when related to reduced gastric motility
Metoclopramide and domperidone
In complete bowel obstruction, GI perf or after gastric surgery do not use pro-kinesis drugs like metoclopramide
How is nausea and vomiting treated in the context of an opiod related chemical disturbance
Treat chemical imbalance
Ondanstrol, haloperiodol, levopromazine
How is nausea and vomiting treated in the context of visceral and serosal issues
Cyclizine and levomepromazine
How is nausea and vomiting treated in the context of raised ICP
Cyclizine
Dexamethasone
Radiotherapy
How is nausea and vomiting treated in the context of vestibular issues
Cyclizine
If refractory- metoclopramide or prochlorperazine
How is nausea and vomiting treated in the context of cortical issues
Anticipatory- short acting benzo- loraz
Cyclizine
