GERMED Final Flashcards
(34 cards)
Explain why you would be inclined to stop amitryptyline in newly diagnosed patient with Alzeimers dementia [1]
Amit: cholinesterase imhibitor and amitriptyline is anticholinergic so would be counter active to the medication for dementia.
Which type of memory is initially affected in Alzheimer’s disease? [1]
Episodic memory - memory of events (times, places, associated emotions, and other contextual who, what, when, where, why knowledge) that can be explicitly stated or conjured.
Which medication would you give for a patient that has motion sickness
Metoclopramide
Cyclizine
Ondansetron
Haloperidol
Levomepromazine
Hyoscine
Which medication would you give for a patient that has motion sickness
Metoclopramide
Cyclizine
Ondansetron
Haloperidol
Levomepromazine
Hyoscine
For chemically-mediated symptoms (for example medications, metabolic derangemenet), aim to treat the underlying cause.
If needed, which anti-emetics could be used? [3]
Antiemetics that may be helpful include haloperidol, metoclopramide or levomepromazine.
Which medication would you give for a patient that feels sick because of raised ICP?
Metoclopramide
Cyclizine
Ondansetron
Haloperidol
Levomepromazine
Hyoscine
Which medication would you give for a patient that feels sick because of raised ICP?
Cyclizine
- Dexamethasone or radiotherapy may be helpful to reduce the pressure-associated symptoms.
Which medication should be given to patients who feel nauseous due to compression from abdominal or pelvic tumours? [1]
cyclizine should be used first-line.
Which medications can you give for agitation in end of life? [2]
For patients in their last days of life, haloperidol or low-dose midazolam may be prescribed
Which medications can be given for respiratory tract secretions in end of life care? [2]
An antimuscarinic such as hyoscine butylbromide or glycopyrronium bromide may be prescribed for noisy respiratory secretions.
Lecture
Describe a metabolic effect of opioid prescription and how you would manage this [2]
Nausea and vomiting – would recommend co-prescription of an antiemetic as required – consider the context of your patient but in general, prokinetic such as metoclopramide should be first line
Which medications can be used if a patient is extremely agitated? [3]
- Midazolam 2.5-5mg 1hrly SC (10mg in crisis)
- Levomepromazine 12.5-25mg 2hrly SC (higher dose than nausea)
- Haloperidol 2.5mg 2hrly SC
midazolam usually first line
What do you need to do in an examination so that you can verify death? [4]
Which investigations would you perform for incontinence? [4]
Urinalysis
* Haematuria (bladder neoplasia)
* Glucosuria (diabetic polyuria)
* Nitrites/ leucocytes - UTI
US abdomen – hydronephrosis/ abdominal mass
Urodynamic flow studies – prior to surgery
Rarely spinal MRI (cauda equina)
QuesMed
What is the gold-standard surgical treatment for stress incontinence? [1]
Mid-urethral sling
Describe the cycle of frailty [1]
Multiple stressors decrease physical reserve. Once depleted enough, a simple stressor (e.g. fall / infection) have a much more steep decline in functional abilities and a slower improvement. May not return to previous base line.
Whilst improving (slowly); get impacted by another stressor, which causes a cycle of frailtly
Which clinical frail scale is used within NHS hospitals? [1]
Rockwood clinical frail scale (CFS)
Describe the different levels of Rockwood clinical frail scale (CFS)
- Active
- Is pre-frail
5 -7 are different levels of frailty
8-9 More palliative and symptom management
NB: acutely unwell patients are meant to be score pre-illness
Describe some of key clinical features of hypophosphataemia (CV; resp; neuro; haem) [+]
Cardiac Dysfunction:
- Hypophosphatemia can impair myocardial contractility, leading to heart failure.
- It may also cause arrhythmias due to its role in maintaining normal cellular electrophysiology.
Respiratory Failure:
- Phosphate is essential for ATP production, necessary for respiratory muscle function.
- Severe hypophosphatemia can lead to muscle weakness, including the diaphragm and intercostal muscles, potentially resulting in acute respiratory failure.
Neurological Complications:
- These can range from confusion and seizures to coma, attributable to disturbed ATP metabolism in the central nervous system.
Haematological Effects:
- Reduced 2,3-diphosphoglycerate levels in erythrocytes affect oxygen release from haemoglobin, leading to tissue hypoxia. Hypophosphatemia can also result in hemolysis.
Rhabdomyolysis:
- Phosphate depletion impairs ATP production in muscles, which can lead to muscle breakdown and rhabdomyolysis.
Hypomagnesaemia may lead to which cardiac consequence? [1]
may predispose to torsades de pointes
How do you manage a patient who hasn’t eaten for > 5 days? [1]
NICE recommend that if a patient hasn’t eaten for > 5 days, aim to re-feed at no more than 50% of requirements for the first 2 days.
Describe what is meant by:
- Athetosis
- Ballisumus
Athetosis:
- slow, complex, snake-like movements predominantly affecting distal extremities
Ballisumus
- large-amplitude sudden, flinging motions often unilateral.
Describe different types of laxatives used, with examples and when they should be used [4]
Bulk-forming: e.g. fybogel - ispaghula husk
- Increase the bulk of stool: triggers stretch receptors and promotes peristalsis.
- Usually offered first line
Osmotic laxatives: e.g lactulose or macrogols
- exert an osmotic effect drawing water into the bowel lumen.
- should be offered after bulk-forming laxatives.
- They are also very effective in faecal impaction and infrequent bowel motions.
Stimulants: e.g. senna
- stimulate the local nervous system within the gut wall that increases colonic contractility and secretions.
- They may be used second-line and better for patients with difficulty emptying rather than infrequent motions.
Softeners: e.g. sodium docusate
- Docusate lowers the surface tension, which leads to water and fats penetrating the stool.
QuesMed
What is the first line laxative for chronic constipation? [1]
A bulk-forming laxative such as ispaghula (along with plenty of oral fluid)
What is the first line laxative for drug-induced constipation? [1]
A stimulant laxative e.g. senna or bisacodyl
