Geris/PC

Question 1

Which drugs are associated with osteoporosis?

Answer 1

Corticosteroids
Heparin
Cyclosporin
Methotrexate, and
Cytotoxic therapy.

Question 2

List some of the causes of dementia

Answer 2

Syphilis
Vitamin B12 deficiency
Folate deficiency
Pellagra
Vascular disease
HIV
Multiple sclerosis

Question 3

Which drugs increase the risk of hypothermia?

Answer 3

chlorpromazine/benzodiazepines

Question 4

What dose would you give for paracetamol?

Answer 4

Paracetamol
– 1g QDS (4 hourly) – maximum 4g in 24 hours
– Reduce to 500mg QDS if <50kg, renal/liver failure

PRN codeine 30-60 mg

Question 5

What dose would you give for an NSAID?

Answer 5

NSAID
– Ibuprofen 400mg TDS max 2.4g/day
– Think about gastric protection, renal impairment, CV, bleeding risk, asthma

Question 6

What dose would you use for codeine?

Answer 6

Codeine
– 15mg QDS up to maximum of 60mg QDS (24 mg of morphine/day)
– PLUS Laxative senna 7.5-15 mg BD

PRN morphine 2.5-5 mg 2-4 hrs
If N/V haloperidol 0.5-1.5 mg PO (SC if vomiting)

Question 7

What dose would you use for morphine sulphate immediate release (oromorph)?

Answer 7

Morphine sulphate
– 5-10mg every 4 hr starting dose (10-20 mg if moving from step 2 to 3 WHO) during day.
– 10 mg/ 5ml
– double dose at night
– Usually after WHO step 2 opioid analgesic but if opioid naïve 2.5mg immed/rel starting dose PRN up to hourly

– once stable on 4 hrly doses can change to 12 hrly MST (morphine slow release tablet)
– PRN = 1/6 daily dose of long acting for breakthrough pain

– take care if patient has renal failure

Question 8

What are the different types of morphine sulphate?

Answer 8

Morphine sulphate immediate release e.g.“Oramorph”
• Onset: ½ hour,
• lasts: 4 hours
• Liquid (does come in tablets – Sevredol)

Morphine sulphate modified release e.g. “Zomorph”
• Onset: 2-6 hours,
• lasts: 12 hours (regular twice daily dosing)
• Capsules

Question 9

How do you convert codeine/dihydrocodeine to morphine?

Answer 9

Divide by 10

Question 10

How do you convert tramadol to morphine?

Answer 10

Divide by 10

Question 11

How do you convert morphine PO to morphine SC?

Answer 11

Divide by 2

Question 12

How do you convert morphine PO to oxycodone PO?

Answer 12

Divide by 1.5 (divide by 3, times by 2)

Question 13

How do you convert oxycodone PO to oxycodone SC?

Answer 13

Divide by 1.5 (divide by 3, times by 2)

Question 14

How do you convert morphine PO to fentanyl patch?

Answer 14

morphine in mg/24hrs divided by 3 to get fentanyl patch ug/hr

Conversion ratio morphine:fentanyl 100:1

Question 15

Which drugs can reduce peripheral sensitisation?

Answer 15

corticosteriods

NSAIDS

Question 16

Which drugs reduce pain by blocking sodium channel conduction?

Answer 16

carbamazepine
lidocaine
mexiletine

Question 17

Which drugs reduce pain by blocking calcium channel conduction?

Answer 17

gabapentin
pregabalin
ziconotide

Question 18

Which drugs reduce pain by enhancing descending inhibition?

Answer 18

nefopam
antidepressants
tapentadol
tramadol

Question 19

Which drugs reduce pain by reducing central prostaglandin transmission?

Answer 19

NSAIDs
paracetamol
corticosteroids

Question 20

Which drugs reduce pain by reducing central sensitisation?

Answer 20

ketamine
methadone
magnesium

Question 21

Which drugs can reduce pain due to cancer related oedema?

Answer 21

corticosteroids

Question 22

Which drugs can reduce malignant bone pain?

Answer 22

bisphosphonates

Question 23

Which drugs can reduce pain from skeletal muscle spasms?

Answer 23

baclofen

benzodiazepines

Question 24

Which drugs can reduce pain from smooth muscle spasms?

Answer 24

antimuscarinics (e.g Hyoscine butylbromide)
nifedipine
nitrates

Question 25

When is a syringe driver indicated?

Answer 25

- persistent N & V - dysphagia - bowel obstruction - coma - patient preference

Question 26

What proportion of people over 80 yrs experience a fall each year?

Answer 26

up to 50%

Question 27

What's the prognosis following a hip fracture?

Answer 27

- only 50% of patients return home | - 30% will die as a consequence

Question 28

By what mechanisms do drugs cause falls?

Answer 28

- sedation - hypotension - bradycardia

Question 29

What blood pressure is associated with an increase risk of falls?

Answer 29

less than 110 mmHg systolic or lower in old people

Question 30

When do ACEi and B blockers have a survival benefit?

Answer 30

When someone has systolic cardiac failure. Most old people have diastolic failure.

Question 31

How do antidepressants and antipsychotics cause falls?

Answer 31

orthostatic hypotension

Question 32

Which score assesses ADL?

Answer 32

Barthel index ``` Feeding Bathing Grooming Dressing Bowels Bladder Toilet use Transfers ```

Question 33

What are the 5 geriatric giants?

Answer 33

``` Immobility Instability Incontinence Impaired mental state Iatrogenic- polypharmacy ```

Question 34

What score do you use to assess delirium? What is the criteria?

Answer 34

CAM confusion assessment method Need 1 and 2 and one of 3 and 4 1. Acute/fluctuating: change from baseline 2. Inattention: can't keep track of what's being said 3. Disorganised thinking: speech rambling/incoherent/illogical 4. Altered consciousness: lethargy/hyper-alert

Question 35

What are the risk factors for delirium?

Answer 35

``` Severe illness Urinary retention New environment Dementia/previous delirium Old age Writhing in pain Neuropsych condition previously Ears/eyes Rx anti-ACh, poly pharmacy Sleep deprivation/surgery ```

Question 36

Which drugs can cause anorexia?

Answer 36

PPPD SCSC LLIFT Me Now ``` Phenytoin PPIs Potassium supplements Digoxin SSRIs CCBs Spironolactone Chemo Lithium Levodopa Ipratropium Furosemide Theophylline Metronidazole Narcotics ```

Question 37

Which drugs affect taste and smell?

Answer 37

DEAN's a Happy Person ``` Dexamethasone Enalapril Amitriptyline Nifedipine Hydromorphine Phenytoin ```

Question 38

What is used to screen for malnutrition?

Answer 38

MUST score (malnutrition universal screening tool) Weightloss Illness >5 days BMI

Question 39

Which drugs increase warfarin effect?

Answer 39

SOFA DEVICE Sulphonamides Omeprazole/cimetidine Fluconazole/ketoconazole/metronidazole Allopurinol/amiodarone ``` Disulfiram Ethanol (acute intoxication) Valproate Isoniazid Ciprofloxacin/clarithromycin Erythromycin ``` Grapefruit juice

Question 40

Which drugs decrease the effect of warfarin?

Answer 40

P CARBS ``` Phenytoin Carbamazepine Alcohol Rifampicin Barbiturates Sulphonylureas ```

Question 41

What can cause oesophageal erosions?

Answer 41

Alendronate

Question 42

Erythromycin + ? can cause rhabdomyolysis?

Answer 42

Statin

Question 43

Which drugs can cause SIADH?

Answer 43

Thiazides TCAs Cyclophosphamide Carbamazepines

Question 44

What scores are used to assess risk of pressure scores?

Answer 44

``` Braden score (higher=better) Waterlow score ```