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PR4152 GERI > IC3: Geriatric Syndromes > Flashcards

IC3: Geriatric Syndromes Flashcards

1
Q

What are the 5 geriatric syndromes?

A

Frailty
Falls
Dizziness
Delirium
Urinary Incontinence

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2
Q

What are the 5 characteristics associated with frailty in the Fried Frailty Scale?

A

Weak → poor hand grip strength, difficulty walking up 1 flight of stairs
Slow walking → >6-7 seconds to walk 10 feet
Low physical activity
Weight loss → 5% or more weight loss in the last year
Exhaustion → fatigue while performing daily activities

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3
Q

What does the bADL acronym DEATH stand for?

A

dressing
eating
ambulating
transferring, toileting
hygiene

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4
Q

What are the 3 interventions for frailty?

A
  1. establishing goals of therapy for PT and OT
  2. nutritional intake w oral nutritional supplements
  3. medication review
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5
Q

What are the 3 key questions to ask for falls?

A
  1. any falls in the past 12 months?
  2. do u feel unsteady when walking or standing?
  3. any worries about falling?
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6
Q

What are the most common mechanisms of FRIDS causing harm? (4)

A
  1. anticholinerics
  2. hypoglycemia
  3. sedation
  4. orthostatic hypotension
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7
Q

What are the explicit criteria for FRIDS? (5)

A
  1. OH inducers (alpha blockers, antihypertensives, vasodilators, diuretics)
  2. opioids
  3. psychotropics
  4. anticonvulsants
  5. anticholinergics
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8
Q

What are the 4 types of dizziness?

A
  1. vertigo
  2. pre-syncopal dizziness (usually bc of OH)
  3. dysequilibrium
  4. unspecified dizziness
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9
Q

Should medication be given for dizziness most of the time? Why or why not?

A

No. Oral medication onset of about 30-60 minutes, most dizziness spells are not frequent and last for a minute

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10
Q

Briefly describe the pathogenesis of Benign Paroxysmal Positional Vertigo (BPPV)

A

Occurs when loose otoconia (canaliths) becomes dislodged and enters the semicircular canals

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11
Q

How should BPPV be managed?

A

by physiotherapist
avoid vestibular suppressants

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12
Q

Briefly describe the pathogenesis of vestibular migraine?

A

Usually due to central pathologies relating to the vestibular nuclei, cerebellum, brainstem and vestibular cortex

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13
Q

Briefly describe the pathogenesis of Meniere disease?

A

Caused by excess endolymphatic fluid pressure leading to inner ear dysfunction, causing vertigo and unilateral hearing loss

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14
Q

How should Meniere disease be managed? (3)

A

take measures to decrease water in ears (eg. lower Na intake, loop diuretics, vestibular suppressant like beta-histine)

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15
Q

Briefly describe the pathogenesis of vestibular neuritis?

A

Viral infection, diagnosed based on clinical history and physical examination, causing severe rotary vertigo (HINTS)

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16
Q

How should vestibular neuritis be managed?

A

use steroid to lower inflammation first and consider short term vestibular suppressant (takes weeks to months to get better)

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17
Q

What does TiTraTE stand for in approaching dizziness?

A
  1. Timing (episodic/continuous)
  2. Triggers (head movement, posture change)
  3. Targetted examination (pt hx)
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18
Q

In what cases should vestibular suppressants be given?

A

Only short term for symptomatic relief if symptoms are prolonged (> 30 min) because almost all are beers list drugs

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19
Q

What are the 7 classes of drugs under vestibular suppressants?

A

1st gen antihistamines
anticholinergics
phenothiazines
bzd
antidopaminergics
ca channel antagonists
type 3 histamine receptor antagonists

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20
Q

What are the 1st gen antihistamine vestibular suppressants?

A

diphenhydramine
dimenhydrinate
meclizine

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21
Q

What is the one anticholinergic vestibular suppressant?

A

scopolamine

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22
Q

What are the phenothiazine vestibular suppressants?

A

prochlorperazine, promethazine

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23
Q

What are the bzd vestibular suppressants?

A

lorazepam, diazepam, clonazepam

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24
Q

What are the antidopaminergic vestibular suppressants?

A

metoclopramide, ondansetron

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25
Q

What is the one Ca channel antagonist vestibular suppressant?

A

cinnarizine

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26
Q

What is the one type 3 histamine receptor antagonist vestibular suppressant?

A

betahistine

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27
Q

In what cases should betahistine be used with caution and is contraindicated in?

A

asthma (risk of bronchospasm from histamine activity)
history of PUD (h2 receptor activity)

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28
Q

What are the 2 main types of delirium?

A

Hyperactive delirium → agitation, inattention, psychosis
Hypoactive delirium → slow response, increased sedation (hard to identify)

29
Q

What are the components of 4AT in delirium detection? (4As)

A
  1. alertness level
  2. abbrevieted mental test 4
  3. attention (reciting months backwards or 30-3-3)
  4. acuity
30
Q

What are the components of abbreviated mental test 4?

A

DOB, age, place, current year

31
Q

I WATCH DEATH is an acronym for causes of delirium. What does it stand for?

A

infectious
withdrawal
acute metabolic d/o
trauma
CNS pathology
hypoxia
deficiencies
endocrinopathies
acute vascular (shock)
toxins
heavy metals

32
Q

What are the 5 main classes of drugs assocaited with increased delirium risk?

A
  1. strong anticholinergics
  2. bzd
  3. z-hypnotics
  4. opioids (esp pethidine)
  5. H2RA
33
Q

What other medications can prolong delirium?
(A CHAD L)

A

antidepressants
corticosteroids
hypoglycemics
anticonvulsants (esp levetiracetam)
dopamine agonists (impulse control)
lithium (too high worsens delirium, too low worsens bpd)

34
Q

What are 11 delirium prevention measures?

4 med related
5 daily living
2 social

A

med related:
1. Medication review
2. Addressing infection and hypoxia
3. Sensory function optimisation
4. Pain management

daily living:
5. early mobility
6. hydration and nutrition
8. bowel movement and urination
8. condusive environments
9. good sleep

social
10. social interaction w loved ones
11. reorientation w clock, calendars and lighting

35
Q

When should pharmacotherapy be started for delirium in elderly?

A

Last resort, only if patient’s behaviours are dangerous (because most of these medications can precipitate delirium)

36
Q

What are the 2 classes of drugs that can be given for delirium in elderly?

A

Antipsychotics
BZD

37
Q

What are the 3 antipsychotics that can be given for delirium in the elderly?

A

SC/IM/PO haloperidol
PO quetiapine
PO olanzapine

38
Q

What are the contraindications for haloperidol for delirium in elderly?

A

QTc prolongation
DLB/PDD

39
Q

What are the benefits of quetiapine and olanzapine for delirium in the elderly?

A

Quetiapine is safe for PD
Olanzapine is safe for QTc prolongation

40
Q

When should bzd be given over antipsychotics in delirium in the elderly? (2)

A

If antipsychotics not tolerated well
1st line for alcohol or bzd withdrawal

41
Q

What are the 2 prerequisites to urinary continence

A

normally functioning lower urinary tracts
adequate physical and cognitive function to use the toilets

42
Q

Which nervous systems are activated and blocked in the bladder FILLING phase?

A

SNS activated
PNS blocked

43
Q

Which two adrenergic receptor activations result in what physiological outcomes during bladder FILLING?

A

β-3 activated: bladder relaxation
α-2 adrenergic activated: tightening of bladder outlets and urethra

44
Q

Which nervous systems are activated and blocked in the bladder VOIDING phase?

A

PNS activated
SNS blocked

45
Q

Which receptor activation result in what physiological outcomes during bladder VOIDING?

A

M3 receptors activated: bladder contraction

46
Q

What are the 4 types of urinary incontinence?

A

Stress
Urge
Overflow
Functional

47
Q

What is stress UI?

A

Increasing intraabdominal pressure (cough, laugh, exercise)

48
Q

What are the causes of stress UI? (2)

A

Weak pelvic floor muscles from childbirth, pregnancy
Bladder outlet or urethral sphincter weakness

49
Q

What is urge UI?

A

Leakage due to inability to delay voiding after sensation of bladder fullness is received

50
Q

What are causes of urge UI? (2)

A

Detrusor overactivity
CNS disorders (stroke, parkinsonism, dementia)

51
Q

What is overflow UI?

A

Leakage due to mechanical forces on overdistended bladder

52
Q

What are the causes of overflow UI? (3)

A

Anatomic obstruction by prostate (BPH)
Overactive bladder
Medication effect

53
Q

What is functional UI?

A

Urinary accidents associated with ability to toilet

54
Q

What are the causes of functional UI? (2)

A

Severe dementia or other neurologic disorder

Psychological factors like depression (no motivation) and dementia (does not know what to do when feeling urgent)

55
Q

DIAPPERS underlines UI causes that are reversible. What does it stand for?

A
  • Delirium
  • Infection (acute UTI)
  • Atrophic vaginitis
  • Pharmaceuticals
  • Psychological disorders, especially depression
  • Excessive urine output (eg. hyperglycemia, SGLT2i can increase urine output and increase UI risk)
  • Reduced mobility (functional incontinence) or reversible drug-induced retention
  • Stool impaction
56
Q

What are the 2 classes of allergy drugs that can contribute to UI?
What are their mechanisms of action?

A
  1. 1st gen antihistamines (decr contractility)
  2. decongestants (incr sphincter tone)
57
Q

What are the 2 classes of analgesics and opioid drugs that can contribute to UI?
What are their mechanisms of action?

A
  1. bzd (impaired function via muscarinic effect)
  2. opioids (decr sensation of fullness)
58
Q

What are the 3 classes of anticholinergics drugs that can contribute to UI?
What is one example of each class?
What is their common mechanism of action?

A
  1. antimuscarinics (oxybutynin)
  2. antispasmodics (scopolamine)
  3. parkinsonian agents (trihexyphenidyl)

(decr contractility via antichol effect)

59
Q

What are the 5 classes of CV drugs that can contribute to UI?
What are their mechanisms of action?

A
  1. ACEi (decr contractility)
  2. alpha agonists (incr sphincter tone)
  3. alpha blockers (decr sphincter tone)
  4. diuretics (incr urine production)
  5. DHP CCBs (selectively dilates arteries, risk of nocturia)
60
Q

What are the 2 classes of psychotropic drugs that can contribute to UI?
What are their mechanisms of action?

A
  1. antidepressants (SNRIs, TCAs) (incr sphincter tone, decr contractility)
  2. antipsychotics (mixed effect)
61
Q

How do caffeine and alcohol contribute to UI respectively?

A

caffeine: incr contractility + irritant (bad for overactive bladder)
alcohol: decr contractility

62
Q

What are the recommended management options for stress UI? (4)

A
  1. Kegel’s exercises
  2. Topical estrogens (may take 2 weeks to 3 months)
  3. Duloxetine (especially if pt is depressed, but not for pts CrCl < 30)
  4. Surgery or devices (but not advisable for elderly who are frail)
63
Q

What are the recommended management options for Urge UI? (7) (some are meds)

A
  1. Kegel’s exercises
  2. Topical estrogen (delayed onset)
  3. Treat BPH in men
  4. Beta-3 adrenergic receptor agonists (mirabegron, vibegron) (ensure that PVR ius not too high if not can result in acute urinary retention)
  5. Antimuscarinic agents, preferably M3-selective agents like darifenacin or trospium (watch out for anticholinergic SE)
  6. Botulinium toxin injection
  7. Sacral nerve stimulation
64
Q

What are the recommended management options for Overflow UI? (3) (obstruction and underactivity)

A

Obstruction: treat BPH in men, encourage bowel habits
Underactivity: bethanechol, clean intermittent catheterisation for women

65
Q

What are the recommended management options for Functional UI? (2)

A
  1. If pt has physical disability, commode or continence pad
  2. If pt has cognitive impairment, get helper to assist
66
Q

What are the 5 types of elder abuse?

A

physical (chemical or physical restraint)
sexual
psychological
neglect
financial

67
Q

What are risk factors for patients to receive elder abuse? (3)

A

dementia
physical disabiloty
poor rs w caregiver pre-morbidly

68
Q

What are the risk factors for perpetrators of elder abuse? (4)

A

caregiver dependency on victims (food, money, shelter)
caregiver w mental health issues (depression, substance abuse)
professional caregiver overwork
victim of domestic violence

69
Q

What can pharmacists do if we suspect elder abuse?

A

Report to social worker

PR4152 GERI (8 decks)

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