Geriatrics Flashcards

Question

What are teh beta 3 adrenoceptor agonists?

Answer 1

Mirabegron

Answer 2

Antimuscurinics | Beta-3 adrenoceptor agonists

Answer 3

tamsulosin, terazosin, indoramin

Answer 4

Finasteride | Dutasteride

Answer 5

``` Neurological diseae (often MS/Stroke) Prolonged cathetarisation ```

Answer 6

No awareness of bladder filling resulting in overflow incontinence

Answer 7

Medical unsatisfactory | Catheterisation only effective treatment

Answer 8

After failure of initial management (Max 3 months pelvic floor exercise Habit training Appropriate medication)

Answer 9

Vesico-vaginal fistula Palpable bladder after micturition or confirmed large residual volume of urine after micturition Disease of the CNS Certain gynaecological conditions (e.g. fibroids, procidentia, rectocele, cystocele) Severe benign prostatic hypertrophy or prostatic carcinoma Patients who have had previous surgery for continence problems Others in whom a diagnosis has not been made

Answer 10

Failure of initial management in constipation/diarrhoea with normal sphincter Referal at onset in >Sphincter damage (or suspected) >Neurological disease

Answer 11

``` Incontinence pads Urosheaths Intermittent catheterisation Long term urinary catheter Suprapubic catheter ```

Answer 12

A reduced ability to withstand illness without a loss of function

Answer 13

3 of 5 criteria ``` Unintentional weight loss Exhaustion Weak grip strength Slow walking speed Low physical activity ```

Answer 14

``` Gait/balance problems Syncope (cardiac/vagal) Chronic diseases (MSK/neuro) Visual problems Acute illness Cognitive disorder Vit D deficiency ```

Answer 15

``` Inadvertently coming to rest on a lower level (/ground) without loss of consciousness and not due to: sudden paralysis, epileptic seizure, excess alcohol or physical force ```

Answer 16

``` Antidepressants (TCAs more than SSRIs) Antipsychotics Anticholinergics/muscarinics Benzondiapeines Anti-hypertensive Diuretics ```

Answer 17

Use of sensory input (prorioception, visual + vestibular) goes to processing centres in brain which causes corrections through muscle movements

Answer 18

``` Sitting to standing ability Static standing balance Romberg test (balance issues when closed = positive) Dynamic standing balance Gait Get up and go test ```

Answer 19

``` Reflex syncope Orthostatic hypotention Cardiac arrythmias Structural carciac/cariopulmonary disease Cerebrovascular ```

Answer 20

Vasovagal syncope >Subset: Carotid sinus hypersensitivity Situational syncope

Answer 21

Postural hypertension >Due to autonomic failure or volume depletion Collapse when stand up

Answer 22

``` Heart failure Onset with exertion Family history of sudden cardiac death/inherited cardiac condition New/unexplained breathlessness Heart murmur On ecg: >Inappropriate, persistent bradycardia >Long/short QT >Abnormal T wave inversion ```

Answer 23

``` Bitten tongue Head turning to one side during episode No memory of abnormal behaviour that was witnessed by another Unusual posturing Prolonged limb jerking Confusion after event Deja vu ```

Answer 24

Prodromal symptoms on other accasions settled by sitting own Sweating before episode Preciptated by prolonged standing Pallor during episode

Answer 25

Dementia Delerium Depression/anxiety

Answer 26

FRAX or QFRACTURE tools | Assess BMD via DEXA scanning if greater than 10% risk at 10 years

Answer 27

Hip Wrist Vertebrae

Answer 28

``` Diabetes/insulin resistance Elderly Chronic disease Lack of use Inflammation Nutritional deficiency Endocrine dysfunction ```

Answer 29

``` Treat cause if possible Strength/balance training Home hazard/safety intervention Medication review Cardiac pacing ```

Answer 30

``` Muscle wasting Muscle contractures Pressure sores Deep venous thrombosis Constipation / incontinence Hypothermia Hypostatic pneumonia Osteoporosis ```

Answer 31

Part of frailty syndrome >Degenerative loss of muscle mass over time DECLINE = risk factors

Answer 32

Psych >Depression >Loss of confidence Social >Isolation >Institutionalisation

Answer 33

Multimorbid Old Frail Complex

Answer 34

A process to assess/manage illness in older patients with frailty Designed to determine what problems are, what we can reverse and make better >Produce a management plan which is goal, not problem, centered

Answer 35

``` Disorientation/delerium Leanred dependancy Deconditioning Iatrogenic harm HAI ```

Answer 36

``` Falls Cognitive loss/delerium Dehydration Incontinence Depression Poor quality of life Loss of functional capacity ```

Answer 37

No regular med review Presumes that patient expects meds Prescribes without sufficient investigation Complex or incomplete instructions for med taking No effort to simply med regime Ordering automatic refills

Answer 38

Pyshiological factors that effect rate but not extent of absorption from GI tract Leads to delay in onset of action >Example reduced saliva production

Answer 39

``` Body composition changes >Reduced body mass >Increased adipose tissue >Reduced water Protein binding changes - decreased albumin Increased permeability across BBB ```

Answer 40

Hepatic metabolism affected by >Decreased blood flow >Decreaed liver mass Leads to toxicity due to reduced excretion/metabolism And reduced first pass metabolism

Answer 41

Renal function decreases with age So does hepatic ability >Increaes half life of drugs

Answer 42

Increased sensitivity to particular medicines >Due to receptor binding changes >Decrease in receptor number >Altered receptors

Answer 43

``` Check if lower dose is recommended - titrate from lowest dose >Lower doses generally needed Review drug regularly Try to avoid drugs for adverse effects Keep regimes as simple as possible ```

Answer 44

``` Onset - when + how rapid Course - does it fluctuate? Is it progressive? Are there any associated features? >Other illness? >Functional loss? ```

Answer 45

Disturbed consciousness Change in cognition >Memory, perception, language, illusions, hallucinations Acute onset and fluctuant Disturbs sleep cycle Emotional disturbance

Answer 46

Extremes of age

Answer 47

``` Infection Dehydration Biochemical disturbance Oain Drugs Constipation Hypoxia Alochol Brain injury ```

Answer 48

Alertness AMT4 Attention Acute change/fluctuating course

Answer 49

``` Mini test checking cognition: 4 questions consisting of: Age DOB Place Current year ```

Answer 50

Always try to treat cause first Pharmacological And non-pharmacologicla measures

Answer 51

``` Sepsis six Blood glucose Medications Pain (do a review) Urinary retention Constipation ```

Answer 52

``` Re-orientate/reassure agitated patients using family/carers Encourage early mobility/self care Correction of sensory impairment Normalise sleep/wake cycle Ensure continuity of care Avoid urinary catheterisation ```

Answer 53

Stop bad drugs (sedatives/anticholinergics) | No evidence drugs help with dilirium, only use if danger to self/others and cannot be settled

Answer 54

An acquired decline in memory/other cognitive functions in an alert persion severe enough to cause functional impairment Present for 6+ months Ie unable to use phone, difficulty washing/deressing

Answer 55

``` Alzheimers Vascular dementia Mixed Alzeimers/Vascular Dementia with Lewy Bodies ‘Reversible’ causes ```

Answer 56

Slow, insidious nset Loss of recent memory first Progressive functional decline

Answer 57

Age Vascular risk factors Genetics

Answer 58

Classically stepwise deterioating Executive function predominate (opposed to memory) Associated with gait problems Vascular risk factors common

Answer 59

May have parkinsons Often very fluctuant Hallucinations common Falls common

Answer 60

``` Onset often at earlier age Early symptoms different to other typpes of fementia >Behaviour change >Language difficulties >Memory not affected early ``` Usually lack insight into ifficulties

Answer 61

``` Support for person/carers Cognitive stimulation Exercise Avoid changes in environment Advanced care planning ```

Answer 62

``` Choliesterase inhibitors (alzheimers) Anti-psychotics (avoid if possible) ```

Answer 63

``` Hypothyroidism Intracerebral bleeds B12 deficiency Hypercalcaemia Normal pressure hydrocephalus Depression! ```