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PR4152 GERI (Adeline) > IC3: Geriatric Syndromes > Flashcards

IC3: Geriatric Syndromes Flashcards

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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
What is the one Ca channel antagonist vestibular suppressant?
cinnarizine
26
What is the one type 3 histamine receptor antagonist vestibular suppressant?
betahistine
27
In what cases should betahistine be used with caution and is contraindicated in?
asthma (risk of bronchospasm from histamine activity) history of PUD (h2 receptor activity)
28
What are the 2 main types of delirium?
Hyperactive delirium → agitation, inattention, psychosis Hypoactive delirium → slow response, increased sedation (hard to identify)
29
What are the components of 4AT in delirium detection? (4As)
1. alertness level 2. abbrevieted mental test 4 3. attention (reciting months backwards or 30-3-3) 4. acuity
30
What are the components of abbreviated mental test 4?
DOB, age, place, current year
31
I WATCH DEATH is an acronym for causes of delirium. What does it stand for?
infectious withdrawal acute metabolic d/o trauma CNS pathology hypoxia deficiencies endocrinopathies acute vascular (shock) toxins heavy metals
32
What are the 5 main classes of drugs assocaited with increased delirium risk?
1. strong anticholinergics 2. bzd 3. z-hypnotics 4. opioids (esp pethidine) 5. H2RA
33
What other medications can prolong delirium? (A CHAD L)
antidepressants corticosteroids hypoglycemics anticonvulsants (esp levetiracetam) dopamine agonists (impulse control) lithium (too high worsens delirium, too low worsens bpd)
34
What are 11 delirium prevention measures? 4 med related 5 daily living 2 social
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
When should pharmacotherapy be started for delirium in elderly?
Last resort, only if patient's behaviours are dangerous (because most of these medications can precipitate delirium)
36
What are the 2 classes of drugs that can be given for delirium in elderly?
Antipsychotics BZD
37
What are the 3 antipsychotics that can be given for delirium in the elderly?
SC/IM/PO haloperidol PO quetiapine PO olanzapine
38
What are the contraindications for haloperidol for delirium in elderly?
QTc prolongation DLB/PDD
39
What are the benefits of quetiapine and olanzapine for delirium in the elderly?
Quetiapine is safe for PD Olanzapine is safe for QTc prolongation
40
When should bzd be given over antipsychotics in delirium in the elderly? (2)
If antipsychotics not tolerated well 1st line for alcohol or bzd withdrawal
41
What are the 2 prerequisites to urinary continence
normally functioning lower urinary tracts adequate physical and cognitive function to use the toilets
42
Which nervous systems are activated and blocked in the bladder FILLING phase?
SNS activated PNS blocked
43
Which two adrenergic receptor activations result in what physiological outcomes during bladder FILLING?
β-3 activated: bladder relaxation α-2 adrenergic activated: tightening of bladder outlets and urethra
44
Which nervous systems are activated and blocked in the bladder VOIDING phase?
PNS activated SNS blocked
45
Which receptor activation result in what physiological outcomes during bladder VOIDING?
M3 receptors activated: bladder contraction
46
What are the 4 types of urinary incontinence?
Stress Urge Overflow Functional
47
What is stress UI?
Increasing intraabdominal pressure (cough, laugh, exercise)
48
What are the causes of stress UI? (2)
Weak pelvic floor muscles from childbirth, pregnancy Bladder outlet or urethral sphincter weakness
49
What is urge UI?
Leakage due to inability to delay voiding after sensation of bladder fullness is received
50
What are causes of urge UI? (2)
Detrusor overactivity CNS disorders (stroke, parkinsonism, dementia)
51
What is overflow UI?
Leakage due to mechanical forces on overdistended bladder
52
What are the causes of overflow UI? (3)
Anatomic obstruction by prostate (BPH) Overactive bladder Medication effect
53
What is functional UI?
Urinary accidents associated with ability to toilet
54
What are the causes of functional UI? (2)
Severe dementia or other neurologic disorder Psychological factors like depression (no motivation) and dementia (does not know what to do when feeling urgent)
55
DIAPPERS underlines UI causes that are reversible. What does it stand for?
- 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
What are the 2 classes of allergy drugs that can contribute to UI? What are their mechanisms of action?
1. 1st gen antihistamines (decr contractility) 2. decongestants (incr sphincter tone)
57
What are the 2 classes of analgesics and opioid drugs that can contribute to UI? What are their mechanisms of action?
1. bzd (impaired function via muscarinic effect) 2. opioids (decr sensation of fullness)
58
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?
1. antimuscarinics (oxybutynin) 2. antispasmodics (scopolamine) 3. parkinsonian agents (trihexyphenidyl) (decr contractility via antichol effect)
59
What are the 5 classes of CV drugs that can contribute to UI? What are their mechanisms of action?
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
What are the 2 classes of psychotropic drugs that can contribute to UI? What are their mechanisms of action?
1. antidepressants (SNRIs, TCAs) (incr sphincter tone, decr contractility) 2. antipsychotics (mixed effect)
61
How do caffeine and alcohol contribute to UI respectively?
caffeine: incr contractility + irritant (bad for overactive bladder) alcohol: decr contractility
62
What are the recommended management options for stress UI? (4)
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
What are the recommended management options for Urge UI? (7) (some are meds)
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
What are the recommended management options for Overflow UI? (3) (obstruction and underactivity)
Obstruction: treat BPH in men, encourage bowel habits Underactivity: bethanechol, clean intermittent catheterisation for women
65
What are the recommended management options for Functional UI? (2)
1. If pt has physical disability, commode or continence pad 2. If pt has cognitive impairment, get helper to assist
66
What are the 5 types of elder abuse?
physical (chemical or physical restraint) sexual psychological neglect financial
67
What are risk factors for patients to receive elder abuse? (3)
dementia physical disabiloty poor rs w caregiver pre-morbidly
68
What are the risk factors for perpetrators of elder abuse? (4)
caregiver dependency on victims (food, money, shelter) caregiver w mental health issues (depression, substance abuse) professional caregiver overwork victim of domestic violence
69
What can pharmacists do if we suspect elder abuse?
Report to social worker

PR4152 GERI (Adeline) (8 decks)

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