Geriatrics

Question 1

What are some reasons why people are living longer ?

Answer 1

Increased resource availability.
Better economic conditions.
Improved screening programmes.
Better outcomes following major events.

Question 2

What is the Stochastic theory of ageing ?

Answer 2

Cumulative damage

Random

Question 3

What is the programmed theory of ageing ?

Answer 3

Predetermined

Changes in geneexpression during various stages

Question 4

How can frailty be defined ?

Answer 4

A susceptibility state that leads to a person being more likely to lose function in the face of a given environmental challenge

Question 5

Name 4 frailty syndromes

Answer 5

Falls
Delirium
Immobility
Incontinence

Question 6

What are some causes of incontinence ?

Answer 6

Extrinsic and intrinsic

Question 7

What is an example of extrinsic factors causing incontinence ?

Answer 7

Environment
Habit
Physical fitness
Diuretics
Constipation
Confusion

Question 8

What is an example of Intrinsic factors causing incontinence ?

Answer 8

Problem with urinary outlet or bladder

Question 9

What are the functions of the bladder ?

Answer 9

Urine storage (400-600ml)

Voluntary Voiding 
(Voluntary relation of external sphincter and involuntary relaxation of internal sphincter and contraction of the bladder)

Question 10

What segments of the sacral plexus increases the strength and frequency of bladder contractions ?

Answer 10

S2-S4

Question 11

Which spinal segments provides the bladder with sympathetic innervation to the Beta adreno-receptors?

Answer 11

T10-L2 (Causes detrusor to relax)

Question 12

Which spinal segments provides the bladder with sympathetic innervation to the Alpha adreno-receptors?

Answer 12

T10-S2 (Causes contraction of the neck of the bladder and internal urethral sphincter)

Question 13

Which spinal segments provide the urogenital system with somatic innervation ?

Answer 13

S2-S4

Contraction of pelvic floor muscles and external urethral sphincter

Question 14

What are some characteristic features of the bladder outlet being too weak ?

Answer 14

Urine leak on movement, coughing, laughing, squatting.

Weak pelvic floor muscles

Question 15

How do you treat it when the bladder outlet is too weak ?

Answer 15

PT
Oestrogen cream
Duloxetine

Surgical:
TVT/Colposuspension

Question 16

What are the characteristic features of the bladder outlet being ‘too strong’ ?

Answer 16

Poor urine flow, double voiding, hesitancy and post micturation dribbling.

Question 17

How do you treat the bladder outlet being ‘too strong’ ?

Answer 17

Alpha blocker (Tamsulosin)
Anti-androgen (shrinks prostate).
Surgery (TURP).

May need catheterized often supra-pubic

Question 18

What kind of incontinence occurs when the bladder muscle is ‘too strong’ ?

Answer 18

Urge incontinence

Question 19

What kind of features are present when the bladder muscle is ‘too strong’ ?

Answer 19

Sudden urge to pass urine immediately.

Question 20

What can cause urge incontinence ?

Answer 20

Bladder stones or stroke

Question 21

How do you treat urge incontinence ?

Answer 21

Bladder re-training

Anti-muscarinics

Question 22

What are the 3 types of incontinence ?

Answer 22

Overflow
Stress
Urge

Question 23

Which drugs relax the detrusor muscle ?

Answer 23

Antimuscarinics (Oxybutinin) and Beta-3 adrenoceptor agonists (Mirabegron)

Question 24

Which drugs relax the sphincter and bladder neck ?

Answer 24

Alpha-blockers (Tamsulosin)

Question 25

Which drugs shrink the prostate ?

Answer 25

Anti-androgen drugs (Finasteride and dutasteride)

Question 26

What is neuropathic bladder ?

Answer 26

Underactive bladder usually secondary to neurological disease i.e. MS or stroke. Can also be due to prolonged catheterisation.

Question 27

What are some of the key features of delirium ?

Answer 27

Disturbed consciousness Change in cognition Acute onset and fluctuant. Disturbance of sleep/wake cycle.

Question 28

What are some things which can precipitate delirium ?

Answer 28

``` Infection Dehydration Biochemical disturbance Pain Drugs Constipation/Retention Hypoxia Alcohol/drug withdrawal Brain injury ```

Question 29

What are some non-pharmacological treatments for delirium ?

Answer 29

Re-orientate and reassure patient. Encourage early mobility and self-care. Ensure continuity of care. Avoid catheterisation and venflons

Question 30

How can you reduce the risk of developing delirium ?

Answer 30

``` Promoting sleep hygiene Early mobilization Pain control Maintaining optimal hydration Regulation of bowel and bladder function Provision of supplementary oxygen if appropriate ```

Question 31

How do drugs cause falls ?

Answer 31

Decrease: BP HR Awareness ``` Increase: Urine output Sedation Hallucinations DIzziness ```

Question 32

Drugs often responsible for falls

Answer 32

``` Antihypertensives Beta blocker Sedatives Anticholinergics Opioids Alcohol ```

Question 33

If the patient states syncope on exertion what should you think ?

Answer 33

Aortic stnosis

Question 34

If the person has an ataxic gait what is the likely cause?

Answer 34

Cerebellar damage

Question 35

If the person has a arthralgia gait what is the likely cause ?

Answer 35

Arthritis

Question 36

If the person has a hemiplegic gait what is the likely cause ?

Answer 36

Stroke

Question 37

If the person has a Shuffling gait what is the likely cause ?

Answer 37

Parkinsons

Question 38

If the person has a high stepping gait what is the likely cause ?

Answer 38

Peripheral neuropathy

Question 39

What are the top 3 drugs most heavily associated with adverse drug reactions ?

Answer 39

NSAIDs Diuretics Warfarin

Question 40

In polypharmacy in the elderly what about absorption of drugs may change ?

Answer 40

Physiological changes occur that affect the rate but generally not the extent of absorption from the GI tract - delay in onset of action.

Question 41

What kinds of body composition changes occur which could affect the distribution of drugs ?

Answer 41

Reduced muscle mass = Increased adipose tissue which increases the duration of action. Reduced body water = Decreased distribution.

Question 42

What kinds of protein binding changes can occur which could affect the distribution of drugs ?

Answer 42

Decreased albumin which decreases binding

Question 43

Hepatic metabolism is affected by what ?

Answer 43

Decreased liver mass | Decreased liver blood flow

Question 44

What are the consequences of disturbed hepatic metabolism ?

Answer 44

Txocity due to reduced metabolism/excretion. | Reduced first pass metabolism - increased bioavailability

Question 45

How does excretion and clearance of drugs change in older people ?

Answer 45

Renal function decreases with age Reduces clearance and increases half-life of many drugs leading to toxicity

Question 46

What are some prescribing tools and guidelines used in prescribing for the elderly ?

Answer 46

Beer's criteria START-STOPP citeria NHS Scotland Polypharmacy Guidance

Question 47

What kind of analgesia is not recommended for the elderly ?

Answer 47

Opiods -more sensitive to effects, lower doses needed. NSAIDs -Increased adverse effects such as renal impairment and GI bleeding.

Question 48

What kind of cardiovascular drugs are not recommended in the elderly ?

Answer 48

Digoxin - Increased toxicity - Lower doses needed Diuretics -Decreased peak effect but reduced clearance

Question 49

Why should you be careful when prescribing anti-hypertensives in elderly patients ?

Answer 49

Exaggerated effects on BP and HR. More likely to be issues with postural hypotension. ACE inhibitors oftwn pro-drugs which may not be metabolized to the active form. Renal adverse effects.

Question 50

How does an elderly patient cope with warfarin ?

Answer 50

More sensitive to this drug. | Greater risk from warfarin related falls and GI bleeding.